The Patient Body: Visual Politics of Abortion

Lennart Nilsson

By Ann Neumann

Nothing has been as damaging to our cause as the advances in technology which have allowed pictures of the developing fetus, because people now talk about that fetus in much different terms than they did fifteen years ago. They talk about it as a human being, which is not something that I have an easy answer how to cure. —Harrison Hickman, Democratic pollster, at a 1989 conference of the National Rights Action League, via Priests for Life website

In 1965, a series of images by Swedish photographer Lennart Nilsson was published in Life magazine: “The Drama of Life Before Birth.” From sperm and egg to embryo to fully formed fetus, the photos represented a decade of Nilsson’s work to capture what the general public had never seen before. To create the images, Nilsson used a variety of innovative photographic methods and equipment which he developed over time, including fiber optics, color filters, and high-definition, three-dimensional ultrasound. The magazine issue sold out immediately. Nilsson’s subsequent work was turned in a book in 1965, A Child is Born, and two award-winning “Nova” specials on PBS: “The Miracle of Life,” in 1984 and “Odyssey of Life” in 1996.

The timing of Nilsson’s work couldn’t have been better for anti-abortion activists who immediately recognized the power of fetal imagery to convey, as words alone could not, the significance and inviolability of human life in the womb. Defeats in the lower courts and the ultimate passage of Roe v. Wade in 1973 convinced the movement that it must take a longer view. Imagery allowed it to work in the cultural realm; if the courts were not on the path to ending abortion, perhaps popular culture was. “The strategy of antiabortionists to make fetal personhood a self-fulfilling prophecy by making the fetus a public presence addresses a visually oriented culture,” wrote Rosalind Pollack Petchesky, a professor at Hunter College, in “Fetal Images: The Power of Visual Culture in the Politics of Reproduction.”

By the 1980s, the anti-abortion movement had aligned itself with the Republican Party. Ronald Reagan’s presidential campaign of 1984 used the movement’s imagery in videos and TV ads. Televangelists took up photos and videos of fetuses as well—and swapped out the clinical fetus for baby.

The effect was, as Pollack Petchesky notes, to bring the images “to life” through photo and digital representation and to transform “antiabortion rhetoric from the mainly religious/mystical to a medical/technical mode.” Pro-choice advocates had no way to counter such a strong visual message. More than 50 years after Nilsson’s Life Magazine special, abortion advocates are still struggling to counter the new, independent context created by fetus imagery.

Looking at Nilsson’s series today (linked above in its original format), one image is recognizably iconic, that of an 18 week old fetus, radiant and floating in a bubble-like amniotic sac. Visible through the translucent skin on its arms, chest and head are a webwork of red veins. One perfect hand is raised to its perfect face, the thumb in its mouth. It is the image of a sleeping infant, eyes closed, head turned to the side, petite and glowing against a black background flecked with star-like matter.

Nilsson, the photographer who “unveiled the life of the invisible,” died last month in Stockholm at the age of 94, long after his technical and artistic photographs changed our conception of fetal life. Whether Nilsson had intended it or not—he never took a position on the legalization of abortion—his work profoundly contributed to the enduring politicization of the fetus in the United States.

The power of fetal imagery is its ability to move the anti-abortion conversation from the realm of religious belief to that of medicine and technology. Larger than life, Nilsson’s fetuses are mesmerizing in their biological significance; singular entities with autonomy and independence (thumb sucking, heart beating). For the first time, the fetus was divorced from women’s bodies, imbued with both personhood and— framed individually, alone—vulnerability. Against a black background, many of these images portray a singular entity, removed from a woman’s womb, floating in space almost like an astronaut.[1] Fresh, radiant, perfect, they capture our attention in a way that potential human life never had.

The elimination of women from the “life” of a fetus had profound significance. As Lisa Wade, a professor at Occidental College, wrote in 2014:

Once the fetus could be individualized, the idea that a woman and her fetus could have contrasting interests was easier to imagine. In many countries even today, the idea that helping pregnant women is helping fetuses and helping fetuses means helping pregnant women is still the dominant way of thinking about pregnancy…. There is power in visualization and its technological advance and these images were a boon to the pro-life cause.

Nilsson’s photographs, for many, were documentation—visual, portrait-like proof—of a demographic or category of human now under assault. Their scientific value undergirded religious groups’ moral argument against abortion, employing public and moral health narratives, not just for women and medical culture—but the nation at large.

The use of imagery by anti-abortion activists has taken various forms in the 43 years since the passage of Roe v. Wade. (Norma McCorvey, or Roe in the seminal case, who later shifted her position on abortion, also died in February.) Bloody images of aborted fetuses became the hallmark of protesters and activists across the country who characterized abortion—almost for any reason at any stage in pregnancy—as a holocaust, a genocide, the grand moral failing which led to America’s implicit downfall. Perhaps the most circulated bloody image is of an aborted fetus the anti-choice movement named Malachi, “my messenger.”

In a digitized three-fold pamphlet created by Texas-based Operation Save America, a color photo occupies the interior center panel. In it, the head, torso and dismembered limbs of a fetus are laid out on white operating cloth. A tape measure is draped along the cloth for scale. The fetus is dark in places, as if burned, severely bruised or decomposing. Blood stains the cloth, the fetus’s head, neck and limbs. It’s a jarring image, one that I recall seeing at an after church event as a young teen in the early 1980s. Adjacent text reads:

Words have failed and we need to see the horrible reality of what we are doing to the weakest among us in our nation. The pictures we carry provide a pictorial essay and a real warning of what horrors befall a culture that turns its back on a Holy God. Our children need to know that the choices they make and the actions they take have lasting consequences.

Fetuses like Malachi are God’s visceral message to us; their images have radicalized generations of activists, believers of all ages who raise enlarged photos above their heads in protest outside clinics across the country (at least the clinics that remain open). Such pamphlets are still handed out today, proof not only of the bloody, state-sanctioned horror that is abortion, but also of the defiant righteousness of the one who hands it.

What’s the origin of photos like that of the “Malachi” fetus? For a 2009 article and photo series for The New York Times, Damien Cave spoke with Monica Migliorino Miller, a professor at Madonna University in Michigan, who claims that “maybe 50 percent of the graphic images of abortion victims that you’ll find online are probably my photography.” Like Nilsson, Migliorino Miller unveils the invisible, but rather than use advanced technological equipment, she digs through medical facility trash. In 1988 alone, Migliorino Miller and her husband illegally retrieved thousands of fetuses from the loading dock of a facility in Chicago where they had been shipped from clinics across the nation. Cave writes:

Mrs. Migliorino Miller said the boxes filled spare rooms in her apartment and others for nearly a year. “We didn’t feel we could put them in storage,” she said. In 1988, Cardinal Joseph Bernardin, archbishop of Chicago, presided over a funeral for around 2,000 of the fetuses. Activists buried many others.

Migliorino Miller “felt it was really important to make a record of the reality of abortion,” she told Cave. Although the “Malachi” photo was misleadingly taken of a fetus that had been kept in a freezer for at least a month and reassembled by a willing OBGYN—and was not taken by her—Migliorino Miller defends the photo because it shows “the humanity” of the fetus, she said. And yet, over the years, she has become more cautious about her own work, attempting to adhere to less misleading tactics (perhaps because of blowback and charges of inaccuracy from abortion supporters?). She avoids graphic images now and photographs younger fetuses because most abortions take place early in pregnancy (more than 80% of abortions occur before ten weeks, yet most images show late-term fetuses).

Another example of the de-contextualizing ability of images is a now-famous photo, taken in 1999 by Christian convert and photographer Michael Clancy. In the photo, gloved hands frame what the viewer realizes is a womb, bloody and round; blue surgical linens surround it. From a hole cut in the top of the womb a tiny hand has reached out and grasped one of the gloved fingers. Clancy took the image while on assignment; he was documenting a fetal surgery for spina bifida. (It is perhaps the best example of what Vienna University’s Ingrid Zechmeiser has called the “fetal patient,” no longer a part of or belonging to the mother but a ward of medicine and society. “Hence women become the object of medical surveillance.”[2])

Clancy publicly claimed that right before he took the photo he saw the uterus shake and the small hand reach out and grasp the doctor’s finger. It was “a slap in the face and a clear calling for a mission,” Clancy said. The doctor, however, refuted Clancy’s claims, stating that both the fetus and woman were under anesthesia and immobile.

Nonetheless, the image was published in USA Today that year and has been widely circulated among the anti-abortion movement ever since. Clancy’s image was powerful, but the message embraced by believers—that fetuses have a life of their own, a will to live, some sentience or awareness of danger and survival, a need for love and, perhaps even display an innate religious belief—is a projection.

“In fact, every image of a fetus we are shown, including The Silent Scream [a widely distributed anti-abortion documentary that used ultrasound from inside the uterus to show a live abortion], is viewed from the standpoint neither of the fetus nor of the pregnant woman but of the camera. The fetus as we know it is a fetish,” wrote Pollack Petchesky.

The anti-abortion movement’s reliance on graphic imagery may have subsided somewhat since the 1980s and 90s, but a new use of imagery has been resoundingly taken up. And not just by activists but also by legislators.

Although sonograms, internal images of a fetus that require special ultrasound equipment, are routinely used before abortions to check the development of the fetus, the power of sonogram images, first used in the late ‘70s, has encouraged anti-abortion activists to push for legislation that requires their mandatory use—and accompanying “counseling” for pregnant women. Sonograms are not medically necessary for these procedures, yet a wave of legislation over the past decade, according to Guttmacher Institute, regulates ultrasound services in 26 states. In fourteen states, ultrasound is mandatory and in four of those, must be shown to the woman. In another ten states the woman must be given the option of seeing the sonogram. The remaining states require that the woman must be given the opportunity to view a sonogram, should she want it.

In some states, the provider must describe the image; in others the woman must wait a period of time after being shown the sonogram. (See Guttmacher link above.) In 2013, a wave of laws requiring mandatory transvaginal ultrasounds (meaning an ultrasound wand is used internally) prior to abortion rightly received national attention. The laws were based on model legislation written by anti abortion organization Americans United for Life, which explained, “Medical evidence indicates that women feel bonded to their children after seeing them on the ultrasound screen. Once that bond is established, researchers argue, a woman no longer feels ambivalent toward her pregnancy and actually begins to feel invested in her unborn child.” Opponents, many of whom claimed the procedure amounted to state sanctioned rape, were largely successful in opposing the laws.

Fetal fetishization has also led to a variety of related anti-abortion legislation across the country: “Personhood” laws attempt to grant fetuses full constitutional rights, including the right to life; fetal pain laws use unsound research to establish pain sensory abilities for fetuses; and 20 week or “late term” abortion bans which use dramatic accounts of grotesque baby murders to enact further restrictions on when and how a woman may terminate a pregnancy, even if doing so will save her life. Yet only 1.3 percent of abortions occur after 20 weeks.

The offer of sonograms to pregnant women is also the strategic obfuscation of Crisis Pregnancy Centers. Often located next to legitimate abortion providers, CPC’s mimic abortion providers in order to trick pregnant women into not terminating their pregnancies. Such centers use the semblance of medical provision—including the offering of sonograms (which require little training)—to promote their ideology about abortion.

Sonogram laws are admittedly only a part of the anti-abortion movement’s legislative assault on abortion access across the country—a total of 434 provisions have already been introduced this year; since 2010, hundreds have been—but sonograms are a strategic assault. Guttmacher writes that, “the requirements appear to be a veiled attempt to personify the fetus and dissuade a woman from obtaining an abortion.”

For some, the image of a fetus can have a mind-changing effect. “I saw this little hand with five fingers, and it was like he was reaching out and saying, ‘Please don’t hurt me,'” Charlotte, a 17 year old from Colorado Springs told Glamour Magazine’s Phoebe Zerwick in 2014. “It was life-changing.” Yet, most women well know when they seek an abortion that there are many—and often larger—issues at stake than what a fetus looks like.

Still, the effect of ultrasound imaging has long been acknowledged. A 1983 article in The New England Journal of Medicine documented two women who decided not to have abortions after viewing sonograms, wrote Sarah Ackley in a 2012 article for the online monthly journal Hypocrite Reader. “The power of images, fetal and otherwise, lies in their ability to communicate simple concepts, but such communication can also divorce them from their complex, real-life context,” Ackley writes.

This is, perhaps, the great achievement of fetal imagery: Its technological or seemingly scientific methods and tropes can very easily be used to further an explicitly religious and political agenda. Science (or pseudoscience) is then able to confer legitimacy on a “moral” conviction. Think of disreputable studies that link cancer to abortion or assign pain sensation to fetuses. Rather than rely on moral or religious arguments to make their case for forced pregnancy, abortion opponents understand that science, however flimsy, can lend their cause greater influence.

The power of fetal imagery—from photos to sonograms—has created a cultural environment in which it is possible to separate and mute the concerns and struggles of pregnant women from that of “their baby,” to prioritize fetal health over women’s and maternal health, and to shroud abortion in shame. That shame has, for generations, silenced women from voicing their own needs, like contraception, sex education, family planning options, and economic concerns. From Nilsson’s fiber optics and color filters to ultrasound wands wielded today under force of law, the power of the image remains the same, to a devastating effect. Pollack Petchesky writes, citing Roland Barthes:

…the power of the visual apparatus’s claim to be “an unreasoning machine” that produces “an unerring record”…derives from the peculiar capacity of photographic images to assume two distinct meanings, often simultaneously: an empirical (informational) and a mythical (or magical) meaning.

By making fetuses into autonomous “babies,” fetal imagery has masked the interdependent and consequential nature of pregnancy. Perhaps the very best example of images’ power to misrepresent, mystify and decontextualize the fetus is the backstory to Lennart Nilsson’s 1965 series in Life magazine. Exalted as a celebration of fetal life, the photos were predominantly of fetuses aborted under Sweden’s liberal laws.

“All but one of the fetuses pictured were photographed outside the womb and had been removed—or aborted—‘for a variety of medical reasons,’” Time notes in its online “100 Photos” collection. “In the years since Nilsson’s essay was published, the images have been widely appropriated without his permission. Antiabortion activists in particular have used them to advance their cause,” the brief caption notes.


[1] Ingrid Zechmeiser, “Foetal Images: The Power of Visual Technology in Antenatal Care and the Implications for Women’s Reproductive Freedom” (Health Care Analysis 9:387-400, 2001, Kluwer Academic Publishers, PDFΑΕ09Κ/Zechmeister%20Foetal%20images.pdf): “The pregnant body has become a kind of ‘empty spaceship’ for the ‘cosmo-naut’ foetus or as expressed more extremely by Annas, stated by Callahan and Knight (1992: 233), the mother’s role is marginalized to being the “foetal container,” a vessel. This metaphor is expressed more clearly in scientific photographs of the foetus which have in common that they make the mother invisible by simultaneously bestowing a status of independence upon the foetus.”

[2]see above


Past “The Patient Body” columns can be found here.


Ann Neumann is author of The Good Death: An Exploration of Dying in America (Beacon, 2016, now in paperback) and a visiting scholar at The Center for Religion and Media, NYU.


Published with support from the Henry R. Luce Initiative on Religion in International Affairs.

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