One question that occasionally comes up in my work is why I support clients who have had abortions and clients who have experienced termination for medical reasons (TFMR). Some people seem to assume these are fundamentally different experiences - or even opposite experiences.

I don’t see them that way. Of course, there are important differences. Every person’s story is unique. The circumstances surrounding an abortion for an unintended pregnancy may be very different from the circumstances surrounding a wanted pregnancy affected by a birthing person’s or fetal diagnosis. The emotions, meanings, and grief associated with these experiences can vary enormously.

But I often find that the sharp distinction our culture draws between abortion and TFMR says more about our discomfort with reproductive complexity than it does about people’s lived experiences.

At its core, TFMR is an abortion. And more importantly, both experiences exist within the broader reality that reproductive decisions are rarely simple, purely voluntary, or entirely involuntary.

Our cultural narratives often push people into one of two categories. On one side are stories that frame abortion as a choice: an active decision made by someone exercising reproductive autonomy. On the other side are stories that frame TFMR as something entirely different: a tragedy that happened to someone who would have continued the pregnancy under different circumstances.

These narratives are often created with compassionate intentions. People who have experienced TFMR may seek language that validates the profound grief of losing a wanted pregnancy. They may want recognition that their experience does not align with stereotypes people hold about abortion. 

I understand that. At the same time, I sometimes wonder what gets lost when we draw too rigid a boundary between these experiences.

Because when we look closely, reproductive decisions often contain both agency and constraint. Someone terminating a pregnancy because of a fetal diagnosis or pregnant person’s diagnosis is making a decision. That decision may feel impossible, heartbreaking, or driven by circumstances they never would have chosen. But it is still a decision.

Similarly, someone ending an unintended pregnancy or ending a pregnancy for reasons outside of a fetal or pregnancy related diagnosis may be making a choice within a landscape of constraints: financial realities, relationship circumstances, caregiving responsibilities, housing insecurity, disability, educational goals, or countless other factors. The existence of agency does not mean the decision was freely made in a world of unlimited options.

In both cases, people are often navigating profound questions about what they can realistically carry, what feels possible, what aligns with their values, and what kind of future they can envision.

The more I sit with people’s stories, the less interested I become in sorting experiences into categories of “real choice” versus “no choice.” Many people don’t experience their reproductive decisions that way. Instead, they describe living in the tension between autonomy and circumstance.

They talk about loving a pregnancy and ending it. They talk about feeling relief and grief at the same time. They talk about making a decision they believe was necessary while still wishing the circumstances had been different. They talk about wanting a baby and not feeling able to continue a pregnancy. They talk about exercising agency while simultaneously feeling that none of their options were the ones they truly wanted.

These experiences do not fit neatly into our cultural narratives. I often think of reproductive decision-making as existing in a space where choice and constraint are constantly interacting. Most decisions are neither completely free nor completely forced. Most exist somewhere in between.

When we insist that abortion and TFMR belong to entirely separate categories, we can unintentionally reinforce a hierarchy of reproductive experiences.

Some stories become more socially acceptable to grieve. Some reasons become easier to understand. Some decisions become easier to justify. And some people feel pressured to distance themselves from others whose circumstances look different from their own.

But I don’t believe reproductive experiences need to be ranked in order to be honored. A person who ended a pregnancy because of a devastating diagnosis deserves compassion. A person who ended a pregnancy because they did not feel able to raise a child deserves compassion. Both of these deserve to be seen as parenting decisions made from a place of love, care, and deep thoughtfulness.

A person who feels grief deserves space for grief. A person who feels relief deserves space for relief. A person who feels both deserves space for both. A person who makes a complex, impossible decision with painstaking consideration for their own well-being, their family and loved ones’ well-being, and their potential child’s well-being deserves to have that labor recognized as care work and parenting (if they feel this resonates - not everyone who has a TFMR or abortion identifies as a parent and that is also valid). 

What I see, over and over again, is that people are trying to navigate complex realities with the resources, information, values, and circumstances available to them at the time.

Rather than dividing people into separate camps, I am more interested in making room for the full complexity of reproductive experiences - and for the humanity that exists across all of them.