Intimacy, Illness, and Forced Gestation

Two weeks ago, I was diagnosed with a chronic illness. The past few months have been a whirlwind of surgeries, IVs, MRIs, and medications. And while the physical pain and uncertainty about my future have weighed most heavily on me, I am also struck by the forced intimacy I have endured. My body has forced me into intimacy with a whole team of medical professionals. They take pictures of my intestines, slice into me while I’m naked and unconscious, and keep track of deficiencies and excesses in my blood.

The medical establishment leaves very little room for control over one’s intimate exposure. If your condition can go a couple months without treatment, and you’re lucky enough to live in an area with multiple specialists and have good insurance, you might be able to switch doctors. But doctors are not the only ones you’re exposed to. There are nurses, receptionists, and other hospital personnel, too. When you schedule an imaging procedure, you’re typically given choices about the time, but not the technician. When your body is in pain or immediate danger, you must accept who’s available. And while we should facilitate greater patient autonomy, the fact will remain that with an incurable illness, I have no real choice but to have intimacies foisted upon me.

As I’ve come to terms with this, and been immersed in thinking about forced intimacy, it’s been impossible not to turn my thoughts towards Roe v. Wade. When one’s body forces one into intimacy, one has to accept it. But sometimes intimacy is forced onto one not by their body, but by a political movement. And this should not be accepted. In this piece, I give a brief overview of my Intimate Zones Account and how it sheds light on the special importance of intimate rights and the egregiousness of intimate violations, and discuss three ways that gestation forces intimacy.

As I write this on June 24th, 2022, Roe v. Wade was overturned. As of this afternoon, twenty-two states have laws in place or in the works to ban or severely restrict abortion access. Philosophers have long given persuasive arguments in favor of abortion rights. They have argued for the moral permissibility of abortion from the overriding importance of bodily autonomy, the moral importance of birth, and the moral status of fetuses. Since the draft opinion overturning Roe v. Wade leaked two months ago, the Blog of the APA’s Women in Philosophy Series has published insightful work. Jordan Pascoe argues that the right to abortion is grounded in the right to ourselves. Alycia LaGuardia-LoBiano argues that we must reframe our classroom discussion of abortion to include “the relevant sociopolitical and historical context of the debate.” These arguments are important, and present sufficient reason to be outraged at the dismantling of abortion rights in the United States. However, understanding forced gestation as an intimate violation gives us important and new insight into why it is so grievous a wrong. It is not only that there is a right to abortion, but that violations of this right are in a special class of grave wrongs.

The Nature of Intimacy

One might think that the fact that forced gestation is a violation of bodily autonomy is sufficient to put it in a special class of grave wrongs. After all, as Pascoe argues, “our right to our bodies is a right to ourselves, and thus, our right to have rights.” But not all violations of bodily autonomy rise to such a level. Not all infringements of bodily autonomy are gravely wrong, nor do they infringe on our rights to our own person. You are not gravely wronged by being required to wear a seat belt in a car. Your right to yourself is not significantly undermined by being required to wear a mask in a supermarket during a pandemic. To treat all violations of bodily autonomy the same, to lack a concept that can distinguish being required to wear a mask from being required to gestate a fetus, is a prime example of a hermeneutical injustice, or the injustice that occurs when marginalized people are denied interpretive resources to make sense of their own experiences. So why is mandated pregnancy so different? Why is it a much more grave violation of our bodily autonomy, and of ourselves?

As Maggie Little astutely observes about what is missing from abortion debates, pregnancy is intimate. And this makes a moral difference. But what is intimacy? And what about its nature makes forced intimacy so serious? Elsewhere, to answer these questions, I develop and defend what I call the Intimate Zones Account. I argue that being intimate with others reveals our Intimate Zones, Zones that are characterized by what I call their Hiddenness and Importance, and that the nature of these Zones grounds our stringent intimate rights. This account can help us understand why it’s so important that we have control over our intimate boundaries, and capture the intuitive thought that intimacy exposes us and makes us uniquely vulnerable.

A feature is Hidden, in my technical sense, if and only if one is disposed to hide it, and would feel psychological discomfort at its being exposed to a general audience. This does not mean that a person always hides this feature from the public. Take, for example, a young woman who decides during the #MeToo movement to publicly share her story of being sexually assaulted. If she feels psychological discomfort at this exposure, then the fact she was assaulted is a Hidden feature. A feature is Important if and only if one believes, fears, or worries that it reveals a facet of one’s identity. One thinks, or fears, or worries that this feature gives insight into who one is as a person. We might believe that our favorite poems importantly reveal our sensitive nature, or fear that our illness makes us gross. Psychological discomfort at the exposure of our Hidden features renders them loci of vulnerability. And the connection to our identity that Important features have means this vulnerability goes to our very core. We can see, then, how intimacy makes us vulnerable in a weighty and potentially person-altering way. And so intimacy without consent is not a violation of bodily autonomy like all others. It is a violation that goes to the core of who we are, and our right to shape ourselves.

Though intimacy is rarely explicitly referenced in arguments, it is often central to public debates. Many conspiracy theories about the COVID-19 vaccines frame them as an intimate threat, for instance. It is (falsely) claimed that the vaccines cause infertility, or are used to implant a microchip that will be used to monitor its recipients. One’s reproductive capacity is an intimate capacity. Data collected about one’s body can reveal health conditions. Data on one’s whereabouts can reveal one’s views about controversial political issues, one’s shopping habits or favorite artists, or if one was having a secret affair. If these conspiracy theories were right, a required vaccination would indeed be a serious violation. It would not be a mild violation of bodily autonomy, a poke in the arm accompanied by a day under the weather, but an intimate one. For those who believe in such conspiracy theories, then, what they believe to be at stake is significant. Requiring they get the shot without adequately addressing their false beliefs could leave them feeling extremely violated.

Intimacy with Medical Professionals:

A pregnant person is forced into significant intimacy with medical professionals. Their uterus will be peered into with an ultrasound machine, their vagina reached into and their cervix felt. They must share details about their diet and have their blood pressure, blood glucose, and urine tested. By the end of the pregnancy, they meet with the doctor weekly. Their vagina and rectum are swabbed to test for bacteria that make vaginal delivery dangerous. And when they deliver, doctors and nurses will spend hours with a view of an area we refer to as ‘private parts,’ and witness them in the agony of delivery, experiencing what is likely one of the most vulnerable and physically difficult events of their lives.

Doctors and nurses are professionals, with broad obligations to keep medical information private. But doctors and nurses are also human beings. And sometimes human beings have judgmental thoughts. As patients, we can be afraid not only of spoken judgment, but also of negative thoughts about us. And these negative thoughts are sometimes verbalized, and sometimes a therapist even writes an article in the New York Times about a “dowdy patient.” When at the hospital for a procedure a few weeks ago, I wondered what incident(s) might have prompted the placement of a sign in the elevator that read “All Hospital Staff: Please be Mindful of Patient Confidentiality and Keep Your Conversations Appropriate.”

Abortion in the United States also typically requires some intimacy with medical professionals. But while getting an abortion rather than continuing a pregnancy will not free one completely of intimacy with medical professionals, it will considerably lessen it. Many fewer appointments are required, and continuous monitoring is not needed. And we safely can and ought to lessen the intimacy that one is required to submit to if one elects to have an abortion. Laws mandating that patients receive (often transvaginal) ultrasounds before receiving abortions, or visit an abortion provider multiple times, are unduly intimately burdensome. In fact, according to the World Health Organization, “the medical abortion process can be self-managed for pregnancies up to 12 weeks of gestation, including the ability to take the medications at home, without direct supervision of a health-care provider.” Though making abortion pills available over the counter in the US faces major political hurdles, abortion pills are available over-the-counter in other countries.

Intimacy with the Public and Government:

Members of the public often feel entitled to intimacy with pregnant people. You don’t have to look far to find stories about strangers touching the bellies of pregnant women without their consent.

Even before the fall of Roe v. Wade, after finding fetal remains in city wastewater, Georgia officials sent the remains for DNA testing in an attempt to find ‘the mother.’ And women have already been convicted of manslaughter after experiencing miscarriages. Now that the protections offered by Roe are gone, there is reason to expect increased incursions into the intimate details of women’s lives and bodies. As law professor Danielle Keats Citron argues, “Our fertility, dating, and health apps, digital assistants, and cellphones track our every move, doctor visit, health condition, prescription, and search. . . Law enforcers can purchase or subpoena data about women’s missed periods, health clinic visits, and resumed menstruation. Prosecutors with an eye to higher office will use that data to make cases against women and girls, especially those who come from marginalized backgrounds.” The threat of prosecution is serious, but even the very monitoring of such intimate data is itself a violation.

Intimacy with a Fetus:

Pregnancy is extreme intimacy with the being one carries. Whereas other kinds of intimacies are possible in many circumstances, this is unique to gestation. And this makes forced gestation uniquely oppressive. As Little powerfully argues “To be pregnant is to be inhabited. It is to be occupied. It is to be in a state of physical intimacy of a particularly thorough-going nature. The fetus intrudes on the body massively; whatever medical risks one faces or avoids, the brute fact remains that the fetus shifts and alters the very physical boundaries of the woman’s self. To mandate continuation of gestation is, quite simply, to force continuation of such occupation. . . whatever the state’s beneficent motives for protecting the interests of the fetus, it matters that the method used for that protection involves forcing others to have another entity live inside them.” The pregnant person shares their womb, their blood, their oxygen, their nutrients, and their immune system. They feel every movement of another being. They’re kicked from the inside. Their body changes shape drastically to accommodate another.

And this extreme closeness, this intertwinement, means the exposure of our Intimate Zones. As Timothy Murphy and Jennifer Parks describe, “A pregnant woman spends nine months in intimate connection to the resulting child, and it is to her body—in all its movements and circumstances—that the fetus is attuned.” This attunement is a sort of intimate knowledge, even though the fetus does not yet have the capacity to form beliefs and so does not have knowledge in the typical sense. And so a pregnant person can reasonably feel intimately exposed to a fetus. This is especially true if the pregnant person projects the fetus into the future, and imagines who they might become. If the pregnancy continues, one day the fetus will become a child. The child will have intimate knowledge of the person who carried them. They will have begun their existence by living inside them.

As Liz Harman compellingly argues, women who are forced to carry a pregnancy to term will often come to see themselves as the child’s mother, and desperately love the child that comes into existence. And so once forced to give birth, adoption will not seem a viable option to them. This means that forcing a woman into pregnancy is likely forcing her into motherhood as well. And to force someone into parenthood, to live with their child for 18+ years, to feed and bathe and hold them, to shape their values and help them develop into adults, is to force them into a life-long and encompassing intimacy.

Parting Thoughts

Thinking about intimacy has helped me make sense of my experience with illness and medical care. It helped me to understand why some medical procedures have felt deeply uncomfortable in a way the physical pain alone could not explain. These procedures have exposed not just my body, but hidden and vulnerable parts of my very self. Pinpointing this source of discomfort meant I could better identify and advocate for alleviations. But like many philosophers, I’d prefer not to be the only person for whom my work can be useful. On my more grandiose days, I hope it might not only help us make sense of a special kind of wrong, but give us another instrument to fight against it.

It is impossible to fully capture the intimacy of gestation in a piece of writing, let alone a short one. But I believe drawing attention to the intimacy of pregnancy, and making a case for the special significance of our intimate rights, is crucial for understanding the severity of the wrong of forced gestation. The fall of Roe v. Wade was a leap backwards for the United States. I hope we can step forward again, and believe that understanding forced gestation as an intimate violation helps lay the path.

The Women in Philosophy series publishes posts on women in the history of philosophy, posts on issues of concern to women in the field of philosophy, and posts that put philosophy to work to address issues of concern to women in the wider world. If you are interested in writing for the series, please contact the Series Editor Adriel M. Trott or the Associate Editor Alida Liberman.

Jasmine Gunkel

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Jasmine Gunkel is a PhD Candidate at the University of Southern California. She works in normative and applied ethics, feminist philosophy, and social and political philosophy. She’s writing a dissertation that develops a novel theory of intimacy. You can find more about her work here.