What do coitus reservatus, mokh, crocodile dung, cedar rosin, frankincense, palasha tree seeds, algae, seaweed, papaya, pomegranate, and half a lemon all have in common? Throughout history and in scattered cultures, they have all been used to prevent pregnancy with varying success rates. Modern methods of birth control, which include hormonal pills, injections, or implants, Intrauterine Devices (IUD), Diaphragms, Contraceptive Sponges, Condoms, and Fertility Monitoring have documented failure rates that vary from one percent to eighteen percent, which means that in an average year, depending on rates of use and choice of contraceptive method, between one and eighteen women out of one hundred will become pregnant. (Not using contraceptives leads to an annual pregnancy rate of 85 out of 100.)
Women who experience contraceptive failure have three choices (as of the time of this writing): they can carry the pregnancy to term and raise the baby; they can carry the pregnancy to term and put the baby up for adoption; or they can undergo an abortion that will remove the embryo or fetus from her body. This third choice — abortion — was legal in America until the mid-nineteenth century when for reasons whose motivation is disputed among historians, medical abortions were banned, as was the distribution of contraceptive information. The 1973 Supreme Court decision, Roe v. Wade made it unconstitutional to ban abortions prior to a fetus’s viability outside the womb. It is now estimated that one in four women in America will choose abortion prior to the age of forty-five.
It is difficult to name an issue that arouses more argy-bargy, more rage, than the debate over abortion. Into this fray Jodi Picoult has stepped, and her novel, A Spark of Light, offers a well-researched and equitable presentation of the various viewpoints. One of the purposes of literary fiction is to inspire empathy for those whose experiences and thoughts may differ from our own, and it is a testament to the power of Picoult’s novel that she does just that. Regardless of one’s personal feelings about abortion, Picoult presents developed characters whose thoughts and feelings are written in ways that create understanding of their ideas. That is not to say that anyone’s ideas about abortion are necessarily going to be changed, but Picoult gives readers a chance to let down their guard long enough to take in the sincere feelings of others. Readers may even find that have moments of blurred vision as Picoult’s characters, who are under stress, drop rehearsed talking points to attempt to bridge the communication gap in poignant admissions and bursts of confessed doubt and pain.
The novel opens with Wren McElroy thinking that “today … was not a good day to die.” She is confronting the possibility of death because she has been taken hostage in the Center, the only clinic in the state of Mississippi where abortions are performed. It is a women’s healthcare clinic, and fifteen-year old Wren has gone there with her Aunt Bex so that Wren can get a prescription for contraceptives. But Wren and Bex happen to be there when George Goddard storms into the clinic and starts shooting, demanding vengeance against those who provided his seventeen-year old daughter, Lil, with pills that caused an abortion. Those trapped inside the clinic include Janine, an anti-choice protester who had gone into the clinic to try to find “evidence” of illegal activity; Olive, an older woman who came in for her annual exam; Joy, a college student and restaurant server who schedules an abortion after being deserted by her lover; Izzy, a pregnant nurse who works at the clinic; Vonita, the clinic’s owner; Harriet, a nurse who assists during the procedures; Graciela, a clinic counselor who educates women; and Dr. Louie Ward, the OB-GYN, who believes that it is his moral duty to provide pregnant women with choices so that they are not injured or killed by back-alley abortions. In addition, in a hospital room a few hours away, is Beth, a teenager who ordered pills online from China and nearly died from the resulting hemorrhage. She has been ordered arrested by an ambitious attorney who wants to charge her with murder.
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Over the course of the day, readers will experience the events at the clinic in reverse chronological order. But Picoult also makes them privy to hostage negotiations. Those negotiations are being carried out by Hugh McElroy, an experienced detective, who did not know that his daughter, Wren, was at the clinic. Hugh with the help of his sister, Bex, has raised Wren since his wife walked out on both of them when Wren was little. He doesn’t know why his daughter went to the clinic, and the thought that she might be pregnant hurts him — not because what she did broke some “moral” rule — but, rather, because she hadn’t trusted him enough to tell him. As Hugh continues to reason with and cajole George, he thinks about how he has raised Wren. While readers see a dedicated father who has sacrificed much for his girl, Hugh wonders if he has made too many mistakes to be a good father.
Dr. Ward knows that he holds a job that makes him the target of violence. Eleven people — including four physicians — have been killed because of their association with women’s health clinics: patient escorts, all gunned down or blown up by anti-choice terrorists. Ward is a Catholic, and even though he knows that the Church teaches that abortion is a sin, as a boy he witnessed his own mother’s death after she attempted an abortion back in the days before Roe. As the day progresses, the injured Ward reflects on the personal history that has led him to this moment, and he remembers women that he has treated and the circumstances that brought them to the clinic. Ward is a Black man, and along with Olive, who is a white professor at the local college, together elucidate the racism that fuels some of the most vehement opposition to abortion.
And as other discussions take place among the hostages, the dangers of pregnancy are also brought to light. The Women’s Atlas, presents a global snapshot of women’s status and the issues that affect women in a series of graphs, maps, and charts, and it includes statistics on these matters. One of the most glaring facts about America is that it has the highest rate of maternal mortality among all of the industrialized nations of the world, and women of color face even greater odds in the United States. American rates of maternal mortality are four to six times higher than they are in Europe and Australia.
Part of the reason that maternal mortality rates are so high in the United States is due to the results of the abortion debate. As states continue to pass increasing strictures against abortion, finding ways to use loopholes in the original Roe decision, laws have been passed that provide more rights to the fetus than to the mother, and which endanger a pregnant woman’s health. For example, laws that allow for “conscience” decisions mean that, as happened in October, 2018, a pharmacist can deny a woman in the midst of the miscarriage of twins the medication she needs to prevent infection on the basis that it goes against his “Catholic beliefs,” and because he claims that she is “lying” about her need for the medication. These laws also include the right to refuse to dispense Emergency Contraception (the “morning-after” pill) that prevents implantation of a fertilized egg, and which can only be taken in a narrow time frame after rape or unprotected intercourse. A recent Supreme Court ruling allows so-called “Crisis Pregnancy Centers” to lie to pregnant women about their options for their pregnancy, and to present false information about future use of birth control. In one scene in Picoult’s novel, a pregnant woman walks into one of these CPCs thinking it is a real medical clinic, and then realizes that during a sonogram, she is being shown the sonogram from a near-term pregnancy in order to convince her that her twelve-week fetus is viable. Finally, in an act of cruelty, certain states now require that the products of an abortion be given a funeral. Such laws are intended to create expensive procedures to be implemented in clinics, many of which are operated on non-profit budgets. Such additional expenses may drive some clinics out of business, as has happened in multiple states as regulations have been created —known as “TRAP Laws,” that have no impact on the safety of abortions, but which create expensive or near-impossible regulations for clinics to meet. With fewer clinics available, women are resorting to unsafe methods for terminating their pregnancies.
In the state of Mississippi, where A Spark of Light is set, Draconian rules make it difficult for women to exercise their rights to choice. There is only one clinic left in the state, which requires women outside Jackson to travel hundreds of miles to utilize its services. Once there, the state has mandated that clinicians must provide incorrect information to those seeking abortion, including the long-ago disproven theory that abortions cause breast cancer. Also, patients are given an ultrasound and the clinician must ask the patient if she wishes to view the ultrasound. Finally, if she proceeds, there is a twenty-four-hour waiting period. The waiting period is medically unnecessary, but is imposed by the state to make it more costly for a woman who has traveled a long distance, forcing her to pay for a hotel room, extra meals, and either more gas or even a second bus ticket if she needs to travel back home during that time. The idea, of course, is that if a woman “thinks” about having an abortion she will choose not to go through with it. In addition, if the patient is under the age of eighteen, she must have parental consent to have an abortion, or she must go before a judge to explain why getting parental permission would provide a danger to her life. All of this must happen prior to fifteen weeks. While Roe v. Wade specifies that abortion is legal up to the age of viability (with intense life-saving measures, some fetuses born at twenty-six weeks may survive). At fifteen weeks, a fetus is incapable of life outside its mother’s womb, but Mississippi forces women to leave the state in order to have the surgery.
In the novel, on the morning the clinic is attacked, Dr. Ward performs an abortion, and Picoult presents a medically accurate account of what is entailed by the surgery. Patients are prevented by a punitive Mississippi law from receiving medication that would help them to relax during the procedure, so Dr. Ward provides a running commentary of what he is doing as a means of dispelling the patient’s fear. Picoult also provides descriptions of the removed fetus that Dr. Ward must examine to determine that all of the tissue has been removed. Throughout the novel, Jodi Picoult allows her characters to voice their objections to abortion without any kind of phrasing that would indicate a lack of respect from the author toward her characters. When pro-choice characters talk about their feelings, there is no hint that Picoult may think they’re correct. Undoubtedly, some will read the book and fear that Picoult has made the anti-choice characters less favorably than those who are pro-choice. But because Picoult depicts the various arguments and laws honestly, she cannot be held accountable if the various lies that must be told in order to deny a woman an abortion make those characters appear less rational or less intelligent. Laws that force medical personnel to lie to their patients about the effects of abortion are reprehensible. It is not reprehensible to present them and let readers decide for themselves.
The measure of great literary fiction, I would argue, is that it includes well-developed characters with motivations that reflect their emotional reality and places them in situations that challenge them to overcome some difficulty or test. I found A Spark of Light to meet all of these criteria. I must admit to wishing that reading this book was required of anyone who ventures a public opinion about the most personal of all decisions.