There has always been a very narrow understanding of the range and type of women who seek abortions. The reality is that happily married mothers, rape victims, transgender men, domestic abuse victims, incarcerated women, trafficked women, and teenagers all number among the people who seek abortion. Abortions also take place for the most wanted pregnancies, with women who seek terminations as a result of fetal abnormalities.

“There should never be any hierarchy of abortion needs,” Juno Carey states in her illuminating new book, A Necessary Kindness. “No one patient ‘deserves’ an abortion more than another.”

Juno’s passion for women’s healthcare is undeniable but it was the overturning of the landmark Roe v. Wade judgement in the US that spurred her to write this book.

“I was driving along one day and there was a discussion on the radio about abortion,” she recalls. “Some guy called in and was saying all of this stuff that was completely false and I thought, ‘Oh god, what he’s saying is really dangerous. It’s going to terrify people’. So I pulled over and phoned in and said, ‘I work in abortion care. You need to put me on air’.”

Juno wrote down some stories about her work in abortion clinics and the real life experiences of the midwives, the surgeons and the women themselves.

While the book chronicles the stories of numerous patients, Juno also weaves in her personal life. She talks about her own miscarriages and IVF treatment, her battle with anorexia and her divorce from her wife.

“I didn’t want it to be me just telling people stories without being vulnerable myself,” she explains. “People want to hear the reality rather than just the moral and political argument, so I thought including something of myself would help to give warmth to a story that people try to make very untouchable.”

Juno’s honesty makes for a compelling read. She’s open about her lack of understanding of abortion when she first started working in clinics, the traumatic experience of witnessing a surgical abortion and the emotional turmoil of turning away women who were over 28 weeks – the legal limit for abortion in the UK.

Given the amount of progress that’s taken place in relation to sexuality, marriage equality and gender issues, why is abortion still so taboo?

“I’m part of the LGBTQ community and I’ve had IVF,” she explains. “I’m so proud of one part of my life – but the other part is still very hidden. I can’t talk as freely about it.”

One in three women in the UK will have an abortion – more than will get a tattoo – and these statistics are broadly similar around the world.

“If you look at the stats, it’s almost impossible that you wouldn’t know somebody that’s had an abortion,” she says.  “There’s two aspects going on: stigma and secrecy,” she says. “The stigma lends itself to secrecy because people don’t want other people to know. They don’t want the shame, they don’t want other people’s judgement. The stigma is then worse because no one is talking about it. It’s a vicious circle between those two things.”

ABORTION ACCESS

One of Juno’s first patients at the abortion clinic was a 16-year-old girl from Ireland. She has seen many Irish women make that journey over the years. Abortion access is available in Ireland since the referendum in 2018, but Juno still has patients travelling from the Republic of Ireland.

“Women who know somebody who’s made that journey historically feel there’s some safety going down that well-trodden road,” she explains. “If the only person you can speak to has themselves gone over to London and gone to this clinic, and that’s your only frame of reference, that’s going to be the one piece of comfort in a completely unknown situation.”

A huge amount of women from Northern Ireland are having to make that journey too. While abortion was legalised there in 2019, access to abortion isn’t easy.

“The problem is staffing and training and ensuring the safety of people. In an area where people are not necessarily agreeable to a clinic being opened, staff safety and patient safety is a massive issue,” she says.

While the short journey to England may not seem like a huge undertaking to some, Juno tells of how distressing it is to know that her patients are likely to lose the pregnancy in the toilet of a plane. Medical abortions, where you take pills, involve heavy bleeding and can be very traumatic.

We touch on the impact that anti-choice protesters have on both patients and clinic staff. Having to run the gauntlet of demonstrators has a distressing effect on patients and can be very intimidating for staff. To add insult to injury, some of these protesters are being paid.

“Salaries are coming from an American religious organisation,” June Carey says. “The protesters that were there on a day-to-day basis, 9 to 5, they’re getting paid by a very wealthy, very vocal American religious institution. You’ll watch them at 5.01pm pack up their placard, even if someone is walking towards the clinic. It does beg the question as to the true reason they’re there.”

I ask Juno how she feels about female anti-choice protesters.

“One of the regular protesters who was there day in, day out was female,” she acknowledges. “I find that very difficult because my life revolves around women. All my training and belief system is about supporting women and strengthening women.”

Since the US Supreme Court overturned Roe v.Wade in June 2022, no one can afford to assume that our reproductive rights are safe.

“I think when one country brings in restrictions, it emboldens the people elsewhere who have also been wanting to bring in these restrictions,” says Carey. “Suddenly they feel like now is their chance. Anti-choice protesting got worse after Roe vs Wade, because they see it as an opportunity of moving over to the right. Abortion is an easy target, because it’s misunderstood. It’s not talked about, people aren’t aware of the reality.

“It comes up in every general election. Every time someone wants to show how conservative they are, abortion is the target. It’s an easy group of people to get onside.”

POSITIVE MOVES

The global scene is not all negative. On March 8, France officially became the first country in the world to guarantee the right to abortion in its constitution. President Emmanuel Macron said he “will not rest” until women across Europe have the same protection.

“While there are increasing restrictions in some countries,” says Carey, “in other countries people will galvanise and say, ‘We don’t want that here, we want to protect our people’. What happened in America has made people really wake up and say, ‘We absolutely need to stop that happening here’. So it needs to be put in the constitution itself as its own individual right.”

Emmanuel Macron

There are also positive steps happening in the UK. The new abortion law amendment proposed by Labour MP Diana Johnson means that any woman who terminates a pregnancy outside of the legal parameters, as happened with Carla Foster recently, will no longer face jail time. Foster was given a two-year sentence in 2023 having taken abortion pills after the legal time-limit.

“Fingers crossed that will pass,” says Carey. “We need to keep fighting and demanding openness and access. You have to believe you’re going to get there. You can’t lose hope in something you truly believe in. You’ve got to keep going for your own sanity. I chose this as a career but it has become a lifelong fight.”

Along with changing laws, Juno highlights how important preventative measures – aimed at decreasing the number of unwanted pregnancies – are. That starts with kids getting proper sex education. As she states in the book, abortion providers don’t want people to need a termination any more than their anti-choice opponents. Unfortunately, there is a huge lack of investment in education.

“Being a midwife in reproductive health,” she reflects, “and also being a mother of both genders, you’ve got to look at the facts in front of you – and the fact is that whatever sex ed we’ve been giving our children is failing them.”

Some parents make the argument that sex education leads to sexualising children.

“We get this argument to do with anything LGBTQ as well,” Juno observes. “There’s this belief that talking about sex or talking about gender to create awareness is somehow a bad thing. This is not taboo, this is part of life.”

SEX EDUCATION

Consent is another important part of this education. A study in 2021 showed that good sex education programmes could reduce sexual violence by 60%. In the same vein, the positive effect of sex education can be seen clearly in the abortion stats. In 2011 under 18s accounted for 8% of abortions. In 2021, it’s 3% – a huge reduction that couldn’t possibly be accounted for by changing attitudes to teenagers having babies.

Sadly, women and girls are still inadequately taught about their own bodies.

“The lack of knowledge that women have is not their fault,” Juno observes. “They just haven’t been taught these things. A lot of people don’t know about their own cycles or contraception options. These are educated women, these are mothers. A lot of the problem is that women are kept in the dark.”

Is speaking out about having an abortion the only way to throw off the shackles of secrecy and shame?

“Absolutely,” says Carey. “If women were present in the conversation I think the whole dynamic would change. Up until now it’s always the same people – it’s pro-choice or anti-choice. It’s the same arguments and same faces going round in circles. There’s this massive void of women’s voices who are impacted, and men whose wives and mothers and daughters have been through these experiences.

“When they try to speak up they’re suppressed because someone says, ‘You can’t say that’. It’s a fear thing. People are genuinely scared that if I say, ‘I’ve had an abortion’, their existing children might be taken away from them. I’ve heard that. Or a woman might want to go for a certain kind of job working with children and think, ‘What if they don’t let me?’ All of these fears stop people talking.”

A Repeal the 8th march in Dublin

Since writing the book, Juno has had many friends and family open up about their abortions.

“The weight you see lifted off these people... Some haven’t spoken about it in 20 years.”

Juno’s interviewees for the book also found the same comfort in speaking out.

“Every single one said how freeing it was to talk about it,” she says. “To be able to talk freely about their experience and process it. To have questions answered that they weren’t able to ask anyone. The more people say it out loud and know that it’s okay, the more people will do it. It’s like any movement where a whole group has been silenced.

“Look how the MeToo movement snowballed. It’s the same with the LGBTQ community. Sometimes we need to put ourselves in uncomfortable positions to change the culture, so we can create a space where people can be more open.”

Juno’s book is essential reading for all men and women, pro-choice and otherwise. One of the simplest lines in the book says it all: “History has shown us that abortion will happen, somehow and somewhere: the choice is only whether you make it safe or not.”

• A Necessary Kindness is available now via Atlantic Books.