A Sad, Quiet Yes

Back in 2015, I voted ‘yes’ to marriage equality with joy, and pride in my country. There was sadness and regret too; it was hard not to think how lesbian, gay and bisexual people had suffered – and still suffer – in this country. But this felt like a huge step in the right direction, a collective decision to acknowledge and embrace a long-marginalised community, and I, like much of the country, celebrated. On Friday next, I will vote ‘yes’ in the referendum to repeal the 8th amendment, but it feels different. If the people vote to make this change, I will be relieved rather than joyful. I am not pro-abortion any more than I am pro-antibiotics. These are not things I enjoy or celebrate. Even when they are the right answer, they’re not an easy answer. They are not without side effects, and I believe there are moral questions over their use, and the questions around antibiotic use pale in comparison to those around abortion. I’m not saying the two carry equal moral weight, just that I see each as, to a greater or lesser extent, a grim necessity rather than something to be celebrated.

I can’t imagine anybody celebrating the end of any pregnancy unless that end comes in the form of a healthy new baby. I don’t think anybody is ‘pro-abortion’ as such, and I certainly am not. I understand that many people sincerely believe the unborn baby is a person with a right to life. I am not sure that they are wrong. I would personally be very uncomfortable with the idea of a healthy mother terminating a healthy pregnancy at, say, 24 weeks. Babies are great. Bring on the babies, like. But I am suspicious of the attitude that seems to value ‘life’ as a pure, abstract concept to the point that it precludes an appreciation of the complexity of actual lives, actual people. How can someone value ‘Life’ so much that they would force a 13-year-old girl, pregnant through rape (and how else could a 13-year-old be pregnant, legally or morally speaking?) to carry a baby to term? Why is the unborn baby so important that its needs trump those of the actual, already living person carrying it? It smacks of a weird preference for the potential over the actual, a prioritising of ‘Life’ over somebody’s actual lived, embodied, conscious reality. I cannot pretend to know what is in the mind and heart of another person but sometimes it seems to me that pro-life advocates think the pregnant person has been sullied by the world and is beyond help, but this pure, clean, new Life might somehow be better and so deserves a chance.

I get why people are afraid of the consequences of repealing the eighth amendment, I really do. Personally, I am scared at the thought of a future in which the right to life rests on some utilitarian calculus. I hate the idea of poor women being forced to abort wanted pregnancies due simply to economic disadvantage. I find the idea of abortion as contraception disquieting, whether I think about the wellbeing of the baby or that of the pregnant person. I consider it tragic that people might feel unable to raise a child with special needs in our society, and that they might feel they have to terminate a wanted pregnancy on that basis. But these are hypotheticals — outcomes that MIGHT come about if we skidded obliviously down some theoretical slippery slope. They are not inevitable outcomes of a ‘yes’ vote. What is inevitable is that, if we vote ‘no’, we, as a society, will be completely unable to help pregnant people who desperately need to terminate their pregnancy, no matter how ‘good’ any of us might judge their reasons to be. The eighth amendment, and the Protection of Life During Pregnancy act, have not worked. If we want anything whatsoever to change in how we care for pregnant people, we must vote ‘yes’. In this referendum, ‘no’ is radical. ‘Yes’ is the middle ground. ‘Yes’ is the safe option. ‘Yes’ is the conservative, prudent choice. Perhaps, for you, like for me, it may be a slightly trepidatious ‘yes’. A ‘reluctant’ yes. A gritted-teeth ‘yes’. An I-don’t-trust-politicans ‘yes’.  A small, quiet ‘yes’.

Fine. So be it. Any ‘yes’ at all keeps our options open, individually and collectively. But a ‘no’ shuts off much-needed choices for individual girls and women, and for us as a society. After all this is over, when the posters have come down and the hashtags peter out, if we vote ‘yes’, it will still be possible to work to prevent abortion in almost all circumstances. There will still be charities, NGOs and civic groups crying out for resources to help families in difficult situations, trying to make it easier for people to raise children. There will still be scientists seeking to improve the outlook for mothers and babies in all kinds of pregnancies. There will still be opportunities to teach young people to deal with their sexuality in healthy and responsible ways. It will still be possible to eliminate the need for abortion in many cases, if that is what we truly want. Despite the rhetoric of the pro-life side, there are no ‘easy’ cases of unwanted pregnancy. If you are pregnant and cannot or do not want to continue the pregnancy, you are in a crisis pretty much by definition. If we repeal the 8th amendment, there is still so much we can do to drastically reduce the number of crisis pregnancies. But we will never be able to eliminate the need for abortion entirely. There will, tragically, always be cases of rape or incest, and cases where there is no prospect of a baby surviving outside the womb. If we vote ‘no’, there will be no way to help people in these so-called ‘hard’ cases. If we vote ‘yes’, we can still have a meaningful debate about how we, as a society, want to deal with reproductive ethics. We can still try to limit the need for abortion. We can still help both the unborn and the born. But if we vote ‘no’, there is no going back. There is no wiggle room, no ‘hard’ cases, no second chance. We will have made up our minds, and, in my view, we will have closed our hearts and minds in a sad and frightening way.

For me and most people of my generation, the ‘yes’ to marriage equality was an easy, joyful, unequivocal ‘yes’. This time around, it may not feel quite so celebratory. But it is, if anything, even more necessary. This is life and death.

Sugar sugar

Today, the tax on sugar-sweetened drinks (SSDs) comes into effect in Ireland. This will mean a 2 litre bottle of Coca Cola, for example, will cost 60 cent more. On balance, I welcome this move. It is clear that we consume too much sugar, and that this is particularly injurious to the health of children. On its own, this measure will not eliminate any threat to the health of the population, but – with rare exceptions such as vaccination programs – this is not how public health campaigns work. Instead, public health is improved by subjecting a given threat to a death of a thousand cuts. The decline in smoking prevalence, for example, cannot be attributed solely to the workplace smoking ban, or to the provision of supports for smoking cessation, or to the increased tax on cigarettes, or to packaging and advertising laws. But taken together, measures like these have a significant impact. The tax on SSDs could function in the same way: Alone, it won’t dramatically reduce the amount of excess sugar consumption, but in conjunction with other interventions, it just might have a positive effect. If I had any doubts about the effectiveness of these taxes, they are put to rest by the fact that the industry opposes them. Their opposition suggests to me that they believe it can reduce consumption, and they, with their billion dollar market research budgets, should know.

So SSD taxes might play a part in reducing excess sugar consumption. Good. I’m all in favour of that. But. But. The point of the SSD tax is not to reduce consumption of sugar; it is, we are told, to reduce childhood obesity. This is where I find myself getting uncomfortable. I believe this is harmful to both slim and fat people. First, when public health messaging constantly links SSD taxes with obesity, it sends the message that SSDs and other high-sugar ‘foods’ like sweets and cakes are only bad for you if they make you fat. It is the case that, if you are genetically predisposed to weight gain, environmental and behavioural factors will cause you to gain weight. But it doesn’t follow that SSDs and other sugary junk are perfectly safe to consume as long as they don’t cause you to gain weight, and it is disingenuous to push this message on parents and the public in general.

In fact, there are lots of good reasons not to let children consume too much sugar, even if they never become overweight. For one thing, the link between sugar and tooth decay is well established. But I think there are deeper worries that deserve consideration here too. I admit this is somewhat intuitive, and requires both more evidence and more argument than I can give here, but my sense is that it is just not healthy to encourage children to develop a taste for extremely sweet junk foods many of which are, in my opinion, deliberately engineered to be ‘more-ish’. I think there is a danger that letting kids consume these things on a regular basis inhibits their ability to appreciate real, healthy food, and disrupts the natural relationship between their bodies, food and drinks. If you are constantly consuming high-calorie ‘foods’ that don’t give you a feeling of satiety, mightn’t this affect your ability to regulate your behaviour in response to hunger and satiety cues? This is potentially most dangerous to families in poverty, who may lack the resources to make a habit of eating fresh, home-cooked food. (Imagine trying to avoid giving your kids SSDs and sugary, processed foods while living in emergency accommodation.) As has been pointed out time and again, unless it is accompanied by measures to improve health education and access to good food, an SSD tax is basically just another regressive tax, impacting hardest on those who can least afford it. In short, the idea that SSDs – and rubbishy ‘treats’ in general – are fine as long as you don’t get fat seems potentially harmful to me.

But if this messaging is potentially harmful to slim people (and slim children in particular), it is even more harmful to fat people, including overweight and fat children. This is because it reinforces the stigmatising conflation of unhealthy eating with fatness. Yet again, our public health institutions are pushing the notion that, if you are fat, you must be over-consuming, and if you are not fat, your consumption must be fine. Yet again, we are being encouraged (subtly, implicitly) to consider weight as the be-all, end-all of health, and to consider fatness as the greatest threat to our collective health. Yet again, fat people – including children – are being constructed as the living embodiment of all that is wrong with western society. But, it is not clear that fatness is always so dangerous, and it is not clear that weight loss is the best or only solution to the problems that are associated with overweight and obesity. In fact, many of those who maintain clinically-significant weight loss certainly would not look slim or healthy to the average person on the street, who has learned what ‘healthy’ looks like from our public health messaging. In short, as fat acceptance advocates are weary from saying, you can’t tell how healthy somebody is just by looking at them. Yet governments and others, whether by accident or design, keep pushing the idea that body size and shape are clear and direct manifestations of over-eating, under-exercising and other unhealthy behaviours. This contributes to the shame and stigma experienced by fat people. Shame and stigma are harmful in themselves, and they are not good motivators for positive behavioural change of any sort.

This kind of problematic anti-obesity messaging is presumably justified on the grounds that it leads to an overall improvement in the health of the population and that this is good for individuals. I think of this as ‘trickle-down’ ethics, and to me it is just as worrisome as its economic counterpart. Just as, in Reaganomic-type economies, the money stops trickling down well before it reaches those who need it most, so the benefits of anti-obesity policies do not make it to fat people. Rather, I suggest, public health anti-obesity messaging is extremely harmful to actual fat people. In short, while this tax may be a good thing for our collective health, the way it has been announced and justified seems to be yet another case of an ‘anti-obesity’ policy that looks, walks and quacks like an ‘anti-obese-people’ policy.