Abortion policy and practice in Greece

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Pergamon

Soc. Sci. Med. Vol. 42, No. 4, pp. 509-519, 1996

0277-9536(95)00174-3

Copyright © 1996 Elsevier Science Ltd Printed in Great Britain. All rights reserved 0277-9636/96 $15.00 + 0,00

ABORTION POLICY A N D PRACTICE IN GREECE E U G E N I A GEORGES Department of Anthropology, Rice University, P.O. Box 1892, Houston, TX 77251, U.S.A. Abstract--Despite its illegality until recently, abortion is estimated to have been responsible for almost half of the sharp postwar decline in the Greek birth rate. This article examines abortion as a part of a Greek contraceptive culture which has taken shape during the postwar period both in response, and in resistance to, a variety of macro- and micropolitical institutions and forces. During much of this period, pronatalist policies and discourses of both state and church combined to foreclose most medical contraceptive alternatives. In contrast, illegal abortion was a relatively safe, medicalized procedure widely practiced by doctors. Even after being legalized in 1980, female medical contraceptive methods continue to be rejected by the great majority of Greek women, and abortion and male methods of birth control remain the principal means of controlling fertility. The article focuses on the specific abortion practices and meanings of three generations of married women living in the city of Rhodes, capital of the Dodecanese Province of Greece's Eastern Aegean, and explores the ways in which they have been shaped by, and reflect, local cultural understandings of the body, health, sexuality, morality, motherhood and childhood, as well as micropolitical relations within the family. Key words--abortion, contraception, Greece, fertility decline

INTRODUCTION

Despite its illegality until recently, abortion is estimated to have been responsible for almost half of the dramatic postwar decline in the Greek birth rate [1]. Today, Greece's fertility rate, one of the world's lowest, has fallen below the level required for replacement of the population. While below-replacement rates characterize Europe generally, the specific context in which these rates have been achieved-exceptionally low use of medical means of contraception, a high pregnancy rate (over three pregnancies per woman), and the highest abortion rate in Europe--mark Greece as an anomaly [2]. In keeping with the theme of this special issue, this article addresses Greek women's intensive and often repeated recourse to abortion through a dual focus: on the one hand, I examine how large-scale sociopolitical and economic structures have constructed a range of 'limiting conditions' around the control of reproduction, and on the other, how women have negotiated the dilemmas and contradictions produced by these structures to enable them to limit sharply their fertility. Specific abortion practices and meanings are explored through ethnographic information for three generations of married women living in the city of Rhodes, capital of the Dodecanese Province of Greece's Eastern Aegean. The dual focus of this article explicitly addresses reproduction as a political construction at a variety of interacting levels [3~5]. I begin with a discussion of the interplay of three powerful macrosocial forces, the state, the Greek Orthodox Church and the medical profession, which have both indirectly and

directly attempted to control women's fertility, mostly in a pronatalist direction. Although significant in various ways, as I shall argue, these loci of power exert an influence which is nonetheless always partial [7]. Furthermore, contradictions and contentions within and among these influential institutions have produced a certain space in which women have been able to resist the discourse of pronatalism. Indeed, in the near-total absence of family planning programs, the sharp postwar fertility drop in Greece has been achieved largely through the improvisations of women (and men) negotiating such contradictions. In the second part of the article, I discuss these improvisations and explore the ways in which they, in turn, have been shaped by, and reflect, local cultural understandings of the body, health, sexuality, motherhood and childhood, as well as micropolitical relations within the family. Far from static, these understandings and relations have been subject to often rapid transformation in recent years, necessitating special attention to generational perspectives as well as to those of social class. Finally, I explore the subjective experiences of women who have had abortions in a Greek Orthodox milieu that equates abortion with the sin of murder, and discuss the emergent moralities women articulate which are often alternative to, and critical of, the dominant morality of the Church. METHODS AND BACKGROUND

This paper is based on 10 months of research conducted over five visits to Greece between 1990 and 1994 on the general topic of the medicalization of 509

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women's reproductive experiences across the life cycle. Eight months were spent in Rhodes City. With a population of over 60,000 inhabitants, Rhodes City is a cosmopolitan and prosperous town, economically dependent on massive seasonal tourism from northern Europe. Two months were spent in Athens, the capital o1"Greece, conducting observations in one of the country's largest teaching hospitals and interviewing professors of obstetrics/gynecology on curriculum content, medical education, and the attitudes of medical educators. In both Athens and Rhodes, I spoke with public officials, midwives, doctors, social workers, educators and counselors involved in family planning as part of my broader study of medicalization. The bulk of the ethnographic information presented in this paper derives from two samples of Rhodian married women. The first consisted of 26 women who were interviewed in the General Hospital of Rhodes 1-3 days after giving birth. Open-ended depth interviews were designed principally around the topics of pregnancy and birth, but also elicited detailed information on reproductive histories. Many were followed by informal discussions which sometimes included husbands, mothers, and mothers-inlaw. One third of this fairly young group of working and middle class women (average age, 24.6 years) had already had one or more abortions. At the hospital I was also permitted to observe and record on a nearly daily basis the stream of medical encounters between women patients and gynecologists, some of which included discussions of birth control and abortion. The second major source of information consisted of a snowball sample of 62 married women ranging in age from 20-70. Lengthy interviews, sometimes requiring two or three visits, included a wide range of topics related to women's reproductive experiences. After initial attempts to generate a random sample failed (women simply would not agree to be interviewed when contacted by phone or after knocking on their doors), women were recruited by tapping a variety of social networks and by announcing the research at the meetings of several organizations and social clubs. A special attempt was made to include roughly equal proportions of 'working' and 'middle' class women. However, in the Rhodian context in which the bulk of the population works in some capacity in tourism, either for wages or as owners of small businesses, these designations are not entirely satisfactory. Ultimately, 'class' designation was based largely on the woman's level of education (adjusted for her generation) and, where applicable, her occupation. THE 'NECESSARY LINK' BETWEEN CONTRACEPTION AND ABORTION: LIMITS AND THEIR EVASION

Abortion and contraception, as Rosalind Petchesky has noted, are 'necessarily linked' in

complex ways; an understanding of the 'contraceptive culture' historically specific to a given society is thus essential to an understanding of abortion practice. [5, 7]. In this and the following section, I explore these interconnections through an examination of the macropolitics of abortion and contraception as these have taken shape in the postwar period in Greece. Three institutions in particular, the state, the Church and the medical profession, have played significant roles in shaping the contours of both policy and practice. Since World War If, state policies toward contraception and abortion have been marked by both continuities and contradictions. Although successive postwar governments have rarely articulated an official population policy, a persistent pronatalism can be detected in a variety of incentives designed to encourage larger families and combat what has come to be known as Greece's "demographic problem". Pronatalist policies have included such direct incentives as lump-sum birth payments and monthly subsidies to families with more than three children (the juridical category of the politekni), among a variety of other special privileges, and such indirect measures as employment protection for pregnant women, maternity leaves, and public nurseries [1]. More to the point, female methods of contraception remained illegal in Greece until 1980. State attempts to encourage larger families have been reinforced by the Greek Orthodox Church, the country's official religious institution. The Church, which prohibits the use of any birth control with the exception of rhythm and abstinence, was also influential in keeping female methods illegal [8]. A term of broad compass, the 'demographic problem' in Greece is widely attributed to the 'underfertility' (ipogenitikotita) of women (although the contribution of other trends, such as labor migration, has also been recognized). Underfertility has come to be regarded by general public opinion, the political parties, the military and many academics as a multivalent 'danger' [9]. In contrast to the discourse on low fertility in other countries of Europe, underfertility in Greece is not represented as dangerous primarily because of the increased fiscal and social burdens of a graying population or because of projected labor shortages (Greek unemployment has been high since the mid-70s). Rather, underfertility is largely regarded as a serious threat to the survival of the 'race', to Greek Orthodox civilization, and more specifically, to Greece's military strength vis-a-vis hostile neighboring states. Among these, the 'Turkish threat' looms largest, with Greece's shrinking birth rate often unfavorably contrasted to Turkey's large and growing population [9, 10]. As a consequence of these perceptions, Greek women are periodically exhorted to bear more children as their patriotic duty, a duty sometimes compared to the compulsory military service of men [9]. However, despite the battery of state inducements

Abortion policy and practice in Greece and official attempts to provoke a sense of what might be called +uterine nationalism', (that is, a sense of the usefulness of women's bodies to the state as a 'technology of nationalism' [11]) the overall trend has been, and continues to be, one of unremitting decline. Consistent with the pronatalism of both state and Church, abortion remained illegal until 1986. In practice, however, abortion was pervasive in Greece's cities decades before legalization, an open secret best described as a 'legalized illegality' [12]. Never backstreet affairs, abortions were typically performed under general anesthetic by gynecologists in their private offices. Contacts with doctors willing to perform abortions were readily made through informal networks. This paradoxical situation was a direct consequence of doctors' success in evading the law. As members of a profession with inordinate prestige and influential networks, doctors were in an advantageous position to play the game of legal evasion, in any event, a widespread and entrenched feature of Greek political culture [13]. Thus, despite the large scale on which illegal abortions were performed, prosecutions of both doctors and women were remarkably rare [12, 14]. In fact, legalization appears to have altered the abortion experience very little. For example, Glikeria, a 39-year-old college teacher, has had four abortions over the last 15 years, two before legalization and two after. All were performed by the same gynecologist, in the same clinic, using similar procedures. Most importantly, doctors' success in medicalizing illegal abortion helped promote its routinization: in contrast to many other areas of the world in which abortion is illegal, Greek women did not have to face risks to their lives and the prospect of leaving children motherless every time they made their abortion decisions. In 1986, a new law permitting abortion on demand for any reason up to the 12th week of pregnancy placed Greece (together with Sweden, Norway, Denmark and Austria) at the most liberal end of the spectrum of abortion law in Europe [15]. Further, abortions were to be covered by the National Health Insurance system, making the procedure virtually free of cost for the majority of women [16]. Legalization had been part of the electoral platform of the socialist party (PA.SO.K.) which achieved power in 1981. However, despite the absence of an organized anti-abortion movement in Greece, opposition from the conservative political parties that had ruled Greece for most of the postwar period and from the Greek Orthodox Church managed to produce a delay of some 5 years. The socialists' position on abortion was part of a package of progressive social and cultural reforms as well as a response to pressure from the numerous Greek women's organizations that had begun to flourish after the fall of the military junta in 1974 [16, 17]. Nonetheless, legalizing abortion was not the burning issue for Greek women's organizations, which were far more concerned with demands for changes in

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Greece's patriarchal family laws, that it was for their U.S. counterparts. Ultimately, it appears, the large and glaring gap between relatively untrammelled abortion practice and abortion law became one of the most compelling arguments in favor of legalization: that Greece's high abortion rate was common knowledge, discussed openly in the mass media, signified to many a breakdown in the moral authority and political legitimacy of the state. Legalization thus became emblematic of the larger need to end the widespread practice of legal evasion and reestablish civic order [12]. Policies toward family planning also changed after the socialists' ascent to power. Prior to that time, only a handful of small private family planning organizations operated in the urban centers. Family planning was largely the affair of individuals [18]. The pill had been known in Greece since the 1960s, but legally could be prescribed only to correct menstrual irregularities, although women who were determined to use it could purchase it without a prescription from a pharmacy [4, 8]. In Rhodes, intrauterine devices were not widely available before the mid-1980s, and both male and female sterilization remained illegal until quite recently. Except for condoms, which could be purchased in pharmacies and corner kiosks, other birth control technologies were not readily accessible and only rarely used. When the National Health Service was established by the socialists in 1983, it included a legal mandate to correct this situation by providing reliable information on medical techniques of contraception. Information was to be disseminated through the new Health Centers which were being built in every part of the country. After an initial rush of enthusiasm, however, government support for these centers soon waned. By the late 1980s, understaffed and undersupported, they were being used mainly for routine gynecological exams such as the Pap test. Similarly, the socialists' initial support for the mass dissemination of information on family planning also quickly eroded. Also beginning in 1983, well-known actors had regularly appeared on informative short television programs, called 'spots' in Greek, to offer detailed information on birth control (among a number of other health-related issues) on the state-controlled channels. While birth control 'spots' were fairly frequent in the socialists' early years, by the late 1980s broadcasts had stopped altogether. Greek family planners attribute the elimination of these spots, which reached a wide national audience, to the intensification of nationalism during the 1980s. Greek nationalism, as noted above, was inextricably linked in official discourse to the 'demographic problem' and more specifically to the underfertility of women [19,20].

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Eugenia Georges THE MEDICALPROFESSION:GATEKEEPERSTO CONTRACEPTION

There is a popular perception in Greece that doctors are largely to blame for the low levels of use of medical contraceptives and high rates of abortion. Reflecting a more generalized mistrust of the medical profession, doctors are said to profit from abortion and are accused of having consistently blocked efforts to disseminate modern methods of birth control in order to sustain a more lucrative trade in abortion [12, 14, 19]. This opinion is voiced by some doctors as well. For example, the gynecologist who headed the Family Planning section of the National Health Service after 1983 not only agreed, but also claimed that doctors were partially responsible for spreading negative reports about the pill in order to promote abortions. Marlene Arnold, in her study of women's health in Crete, quotes a doctor as saying "Of course I don't freely offer birth control information. Do you think I could keep a clinic like this open, if I only had fees from births?" [14]. In fact, a survey conducted in the early 1960s found that 42% of all private clinics in Greece were run by obstetricians despite the fact that the number of live births during that period would have been insufficient to support them [21]. In any case, contraception was not included in medical school curricula until after 1980 [1]. It is clear from several sources that until very recently, women undergoing abortions were rarely counseled on birth control. For example, one survey of Athenian women found that as late as the mid1980s only 13% of those who had an abortion received any kind of birth control information afterward [22]. Particularly dramatic confirmation of the general lack of counseling emerges from the experiences of older women who had undergone repeated abortions. For example, three Rhodian women in their 50s had had eleven or more abortions, and psychologist Despina Naziri describes in detail the case of a 45-year-old woman from Thessaloniki who had lost count after eight or nine [12]. None of these women had ever asked their doctors for birth control information, nor did the doctors offer any. In the past few years, this situation has been changing rapidly. Changing attitudes were particularly evident in the younger generation of doctors I interviewed and observed in the public hospital in Rhodes. For example, one young resident was appalled when he heard an older midwife tell me that it was unofficial policy in the large Athens hospital where she was trained not to advise women on birth control after an abortion. In his opinion, such conduct was "absolutely unethical". He himself, like some of the other young doctors I interviewed, regards abortion with some distaste: "I became a doctor to give life, not to take it." Another doctor, who follows the anti-abortion movement in the U.S. via CNN, told me he not only tries to talk women into contraception; he also tries to talk them out of

abortions. In the numerous clinical encounters I observed, when women asked these doctors about birth control, they were usually provided with detailed information. Since the legalization of contraception and the establishment of the National Health Service in the 1980s, doctors and professional midwives continue to play an important role as gatekeepers, now channeling women toward certain birth control choices and blocking others. Today, Greek women have basically two medical methods readily available to them, the pill and the IUD. Female barrier methods, such as the diaphragm, were held in very low esteem by all of the gynecologists with whom I spoke. In any case, spermicides, which must be imported, are only intermittently available in Greece. Olga, a 39-year-old shopkeeper who had lived in Australia for over 10 years, described her difficulty in trying to obtain a new diaphragm once she resettled in Rhodes. The gynecologist she consulted was unfamiliar with the device, suggesting instead that she use the IUD. She had in fact tried it some years before, but had had it removed because of the severe and continuous bleeding it caused. Ultimately, Olga overrode her embarrassment and wrote to her son who was still living in Australia, instructing him to go to the National Health Service, have her diaphragm prescription renewed, and send it to her. Sterilization, as noted earlier, was illegal until very recently. Today, tubal ligations are occasionally performed, particularly on women with numerous children or a second caesarean section. Only a negligible 0.1% of Greek women of reproductive age have been sterilized [1]. Vasectomies are almost unthinkable. Negative attitudes on the part of providers may have influenced access to sterilization (as has been the case in France and Spain) [1]. A professor of obstetrics and gynecology in Athens told me he only suggests sterilization to women who have already had numerous children, and never to men, because "somehow [the husband] will feel he is less a man, that he is diminished somehow as a man. Also women have that impression--if you do tubal ligation, something will be missing. Women ask, 'What will happen to me afterward?' So imagine what a man will say". The few women who did want to be sterilized often had to convince their doctors to perform the operation.

WOMEN'S RESISTANCE TO AVAILABLE MEDICAL CONTRACEPTION

Despite the increased availability and accessibility of options after 1980, Greek women's resistance to medical means of contraception has been massive: in 1990, just 2% of women of reproductive age were estimated (on the basis of annual sales) to use the pill. National figures for the IUD are unavailable, but data from Athens suggest that only about 4% of women there used it [19]. Among the women I spoke

Abortion policy and practice in Greece with slightly over one-fifth had tried a medical method at some point, but only 11% were currently using either the pill or the IUD. Greek women conceptually distinguish between medical methods of birth control, called 'contraception' (antisillipsi), and the use of non-medical techniques, called 'being careful' (proseho) [12]. Although 'contraception' has been massively rejected, married women do have very high rates of 'being careful', largely through the use of coitus interruptus (called travigma, or 'pulling out') and condoms [1]. The rhythm method is used by a few, but generally speaking, Greek women are either uncertain or mistaken about where in their cycle their fertile days fall [14, 22]. A commonly expressed belief is that a woman is fertile some 4-7 days before and/or after her period, a belief known from Hippocrates, and linked to the perceived 'openness' of the womb during menstruation and therefore its greater receptivity to fertilization at that time [23]. However, unless a woman has learned her biomedical lessons regarding the female reproductive cycle--typically, from a popular health manual or friends or, less probably, her doctor--she was highly unlikely to use traditional understandings of rhythm to regulate her fertility. In fact, many women who relied on coitus interruptus and condoms expected their husbands to 'be careful' each and every time the couple had intercourse, the implication being that there was no reliable 'safe' period. That Greek women know about the pill, but very few use it, is often attributed by scholars, doctors and family planning activists to the 'pill scare' propagated by the mass media. Indeed, for those women who said they did not want to take the pill, fear of cancer, often specified by site ('breast', 'uterine') was the most frequently mentioned reason. However, although the media undoubtedly have played a role in disseminating information as well as misinformation about the pill, women also drew heavily on their own personal experiences, as well as those of relatives and friends, enumerating such specific undesirable 'side effects' as weight gain, nausea, dizziness, loss of interest in sex, phlebitis, 'nerves', and the fear of forgetting to take them as deterrents to pill use. One young working class woman summed up an attitude widely voiced: "if I knew they wouldn't do me harm, I would use them". When women did decide to use the pill, it was often despite their own uneasiness and the pressure from friends, mothers, and in some cases mothers-inlaw, to stop lest they ruin their health and future ability to bear children. The IUD was a somewhat more acceptable method, but, here too, personal experience and other women's accounts of side effects deterred many from using the device. Even women who experienced no adverse effects would periodically stop taking the pill or have the IUD removed, to 'give the body a rest'. Coexisting with fears of modern techniques informed by biomedical concerns (i.e. fear of cancer,

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concern over 'side effects'), were qualms rooted in women's alternative, ethnomedical understandings of the body and health. Scientific medical knowledge began to dominate women's reproductive experiences in earnest in the postwar period. Throughout Greece, pregnancy, birth, and abortion have been fully medicalized for at least a generation, and in urban areas, even longer. Throughout the island of Rhodes, lay practitioners have been extinct for some two decades. Yet, while much local knowledge has been displaced by Greek biomedicine, particularly among the younger generations of urban women, it was nonetheless often implicit in their explanations for rejecting contraception. As Arnold [14] has noted for women in rural Crete, in ethnomedical discourse well-being is intimately associated with the proper maintenance of boundaries between the 'inside' and 'outside' of the body. 'Inside'/'outside' is an opposition that is among the most salient and productive tropes in Greek culture [24]. For example, in the domain of social relations, 'inside' is associated with those who are classified as 'our own' (dhiki mas), a flexible category of inclusion whose membership varies depending on the context: that which is 'outside' connotes the 'foreign' or the 'other' (kseno). In village life, women have particular responsibility for guarding the integrity of boundaries by keeping dirt and pollution outside [25]. Those who do so are praised for being 'clean', a designation laden with moral implications. The inside/outside distinction is pertinent to the discourse of health maintenance as well. For both the social and the physical body, the 'foreign', with its disruptive potential, is usually suspect, potentially polluting and injurious to well-being. Maintaining health, then, involves upholding the integrity of bodily boundaries, with the orifices representing sites of special vulnerability [25, 14]. In particular, the health discourse on inside/outside implicitly informed many Rhodian women's reluctance to use the IUD. The most commonly heard objection was the formulaic: "'The IUD is a foreign body [kseno soma] inside my body." When pressed, women elaborated on the variety of dangers and anomalous consequences attendant upon violating the integrity of body boundaries. Thus, "the IUD can become one with your flesh; it will be impossible to remove it". "I'm doing something not entirely natural. I've introduced something inside me. I do damage to nature, to my organism". Three women told me similar cautionary stories about the IUD becoming sucked up into the womb, with women later giving birth to babies who had the device dangling from an ear, or clutched in their fist. In an interesting example of the adaptability of the logic of boundary maintenance, and of the possibility of its pragmatic application, one woman told me she didn't want to take birth control pills, "because they are a foreign.., a foreign organism [sic] in your organism...even an aspirin you take, it's a foreign organism". Yet, she decided to try the

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IUD, she said, because "it is outside of the organism, outside of the uterus". Rhodian women sometimes asked me what contraceptive method I used. When I described the diaphragm (as noted above, few were familiar with it), a common objection was that this method was also problematic because I was still introducing foreign substances and objects into my body. In contrast to the multiple dangers inherent in 'contraception', coitus interruptus was sometimes described as a 'more natural' [pio fisiologhiko; pio fisiko] method of birth control. Pills and the IUD, in contrast, were sometimes called 'unnatural'. It has been suggested [27, 12, 14] that what makes coitus interruptus 'natural' and, thus preferable, for Greek women is the possibility of conception it leaves open: since sex and conception are regarded as inseparable, without the possibility of pregnancy, women could not experience sex as pleasurable or desirable. For the Rhodian women I spoke with, however, medical methods were described as unnatural not because contraception itself was seen as an unnatural act. Furthermore, fear of pregnancy often negatively affected women's pleasure (as Beyene [18] has reported for a village in Evia: "stress for Greek women was caused by constant worry about unwanted pregnancy"). Rather, use of the idiom of 'naturalness' appeared to reflect women's expressed anxiety over the health consequences of introducing 'unnatural' foreign substances and objects such as the IUD and the pill into the body on a long-term basis. The ethnomedical logic underlying the concept of 'naturalness' was tellingly illustrated when women extended this idiom to new domains. Thus, Kiki, a restaurant cook with three children, said she decided to have a tubal ligation because 'it is the most natural method'. Sterilization was 'natural', she explained, because it permitted free sexual expression, without the health risks posed by both contraception and abortion.

GENDER RELATIONS AND THE SEXUAL POLITICS OF COITUS INTERRUPTUS

Debates over the nature of gender relations in Greece, on the one hand, and over the sexual politics of coitus interruptus, on the other, converge on the issue of the degree to which women exercise power in conjugal relationships. Discussions with Rhodian women suggest that while it is true that reliance on coitus interruptus is a means of 'pass[ing] the responsibility of birth control to men' [26], it is equally true that women's assertions of their own needs are often necessary to ensure men's effective cooperation [7, 27, 28]. From this perspective, the abortion rate can be interpreted as an index of conjugal conflict, 'representing, as it does, women's fierce determination to terminate pregnancies that their husband had not been conscientious enough to prevent' [29].

Comparison of the experiences of the oldest and youngest generations of Rhodian women suggests that younger women were in a stronger position to assert their own needs and obtain their husbands' cooperation. Although older women were more reluctant to talk about sexual relations, they were more likely to complain of non-cooperating husbands. In contrast, younger women's discussions of coitus interruptus revealed a greater ability to effect compliance. Thus, Kiriaki, a 29-year-old middle class housewife, told me she and her husband relied solely on coitus interruptus, but that, "if I don't remind him, he forgets to". I asked Irini, an 18-year-old working class housewife, if the fact that they always used this method didn't bother her or her husband. She assured me it didn't, explaining that she found it no obstacle to her own sexual satisfaction (although some women did). As for her husband, she said, "it's only a moment" and he was "used to it". Smaro, 24 years old, was blunt: "so let the man's pleasure be diminished". A hospital social worker who frequently counseled Rhodians on contraception summarized women's feelings toward the use of coitus interruptus as a major means of birth control by using the common Greek expression: "why me, and not him?" (ghiati egho ke ohi ekinos?). In other words, she explained, why should I be the one to take the health risks and bear the discomforts of contraception? Thus, while none of the women (or the few men) I spoke with explicitly referred to coitus interruptus as a 'burden' or 'sacrifice', as Schneider and Schneider have reported for rural Sicily [30], a sense that it might represent something of a sacrifice of the husband's pleasure was nonetheless sometimes implicit, as exemplified by Smaro's comment. This 'sacrifice' was one younger women evidently were more able to exact from their husbands. Of course, it is also true that younger women had more contraceptive options. For some, it was uncooperative husbands that led them to overcome their often considerable anxieties and adopt medical techniques of contraception. The way abortion decisions were made also differed somewhat between the generations, reinforcing that impression that at least some men came to accept the necessity of restricting family size later than women. Thus, whereas younger women almost always made the decision to abort jointly with their husbands, women in their late 50s and 60s were more likely to have, at least on occasion, quietly taken abortion decisions on their own [cf 14]. As I argue in the following section, differences in contraceptive cooperation and abortion decisionmaking between the generations reflect changes in models of conjugal relations and, perhaps more importantly, in married women's and men's understandings of themselves and their roles as parents. These changes had clearly already begun when the older generation of women were bearing their children in the 1960s, but intensified in succeeding generations. Generational differences suggest that while

Abortion policy and practice in Greece men might have initially lagged behind women somewhat, ultimately they came to agree with them about the desirability of severely limiting family size. THE GOOD MOTHER

Today, husbands and wives generally agree that the two-child family is the ideal, although in practice many families have only one child [18,26, 31]. To describe ideal family size and composition, young women often gave the emphatic response: "a boy, a girl, and finished!" (ena aghori, ena koritsi, ke terma, r) While Rhodian women may sometimes express admiration for the large families of the past, or echo official pronatalist discourse by declaring that large families are good for Greece, they also disparage women who bear many children by calling them "rabbits" (kouneles). As in the past, marriage and children continue to be inextricably linked in the Greek ideal; the social pressure to produce offspring is acute and newly-weds often do not contracept at all, beginning only after the first child is born in order to space subsequent birth(s). Similarly, motherhood continues to be not merely esteemed, but idealized and celebrated. However, in an apparent paradox, abortion is regarded by many as fully compatible with contemporary ideals of the 'good mother'. That is to say, fertility has become decoupled to a significant extent from motherhood, as the latter has come to involve far more intensive investment of time, attention, energy, money, responsibility and, according to many women, anxiety and stress (anhos. stres) than in the past [32, 33]. In turn, this intensive maternal investment, which some observers regard as 'overinvolvement', is occasioned by and reflects changing understandings of children and childhood [32]. By this logic, being a good mother necessarily entails bearing fewer children. Maria, a 34-year-old working class housewife, expressed a view commonly heard from women from a range of social backgrounds (although middle class women usually specified higher educational goals than Maria's): Of course it's good to have only a few children, because we can help them advance in society better. When you have four or five children, you can't take care of them equally, as well as you can two. It's not a question of saying [as in the past] "children are happiness" [ine eftihia ta pedhia]. The question is, how are you going to raise them, how are you going to help them, to advance in their studies--to finish middle school, go to a technical school, learn a foreign language--help them with money, economically and socially--everywhere. Changing conceptions of what constitutes a good mother nonethelesss exhibit interesting and significant continuities with older understandings of the married woman's crucial role as 'domestic economist' (economologa. economa) who, through the energetic exercise of her management skills, enhances the social standing of the household [34, 35]. Since married women ideally and in practice often stop working

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outside the home after the birth of the first child, their principal sources of self-esteem and prestige continue to derive from the successful management of the household. However, standards of social and economic success have become substantially higher in postwar Greece, and this was perhaps especially true in prosperous and cosmopolitan Rhodes [31, 34]. As Maria's quote suggests, of critical importance in this regard have been higher standards of education for children. Children's education has become particularly valued not only as an avenue to social mobility but also as symbolic capital and a sign of ~distinction' that redounds to the entire family [36, 37]. Achieving this goal involves considerable maternal effort: forgoing children's labor inside as well as outside the household, and, if they are to pass the highly competitive Panhellenic college entrance exams and attend the prestigious public universities, or learn a foreign language to increase their job marketability, tutoring and/or transporting children to costly private cram schools on an almost daily basis. More labor-intensive standards of housework and the spreading ideal of European bourgeois femininity which dictates greater investment in women's self-care and appearance make additional demands on women's time and energy [33, 35, 38]. In the context of these substantial changes, both women, who bear the brunt of child caretaking, and men, who shoulder most of the responsibility for the family's material success, usually come to agree on the necessity of limiting family size in order to be good parents. Thus, when women found themselves undesirably pregnant because the usual techniques of birth control failed, or failed to be used, abortion was almost always an option to be at least considered. In light of the forgoing discussion, it is revealing that Rhodian women overwhelmingly explained their abortion decisions in primarily 'economic' terms. In particular. as I discuss in the following section, preventing unborn children from "going hungry' and "suffering' material deprivation were stereotypical expressions used by women of both working class and middle class backgrounds to explain their abortion decisions. However, in the context of late modernity in which most of Greece is situated today marked as it is by, among other things, radical changes in the actual and ideal quality of life over the last three decades--the 'suffering' and "hunger' to which Rhodian women referred was generally relative. Although the economic logic women adduced for their decisions to limit the number of births to one or two dovetails nicely with the dominant discourse on women's centrality to the proper management of the domestic economy, it provides scant solace in a Greek Orthodox context which equates abortion with murder. In the following section, I examine how many women have reworked the moral qualities implicit in their mandate to properly manage households into a new, alternative morality of abortion.

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Eugenia Georges SIN AND PITY: ALTERNATIVE MORALITIES OF ABORTION

This section examines the moral contradictions inherent in the pervasive practice of abortion in a Greek Orthodox context and women's responses to the dilemmas that arise from their reproductive experience. The Greek Orthodox Church, to which the vast majority of Greeks belong, considers abortion a major sin (amartia), which has to be confessed as murder [39]. According to Church doctrine, women who have had abortions cannot receive the ritually purifying sacrament of Holy Communion until immediately before their death [1]. In practice, however, the Orthodox Church has never been as staunch or vocal an opponent of abortion as has the Catholic Church [16]. In a recent historical study of the Greek family, Sant Cassia [40] suggests that the sexual status of the priest (married and non-celibate) and his often popular social origins may have helped keep the Church open to local practices and beliefs, especially regarding personal matters such as sexuality, and the related issues of contraception and abortion within marriage. The stories of Rhodian women who confessed their abortions to priests reveal that, in fact, Church practice may often be flexible and pragmatic. The example of Niki, a 29-year-old working class woman who has had four abortions over the last 7 years, is a case in point. During this period of time, Niki did not take Communion, because, as she explained, "knowing that it was forbidden, I did not want to mock God". After the last abortion, feelings of remorse which she had experienced to some extent from her first abortion became even more troubling, prompting her to go to confession. According to Niki, "I asked forgiveness and I confessed. He [the priest] blessed my belly with holy water and told me, 'Look, once God can forgive you. He can't forgive you over and over.' And I believe God forgave me. I want to believe that. Also the Church forgave me". Niki began taking Communion again, and in fact was 7 months pregnant with her second child when I interviewed her. Similarly, Despina, an economically comfortable housewife in her 40s, had abstained from taking Communion for 15 years because of her repeated abortions (a total of seven). When she finally confessed, the priest responded that 15 years without Communion had been penance enough: she should resume taking it immediately. I should also note that although some women who had abortions avoided confession, many continued to see themselves as religious, attending church regularly, fasting and taking Communion anyway [cf 41]. Women's ordinary language use highlights the moral contradictions and dilemmas of abortion in a Greek Orthodox context. Strictly speaking, ektrosi (and the more formal and less frequently used, amvlosi) are the Greek words for abortion. Women also sometimes use biomedical euphemisms such as

apoksesi (curettage) and apovoli (miscarriage) which ambiguously can refer either to mandatory medical procedures or acts of nature. However, these are medicalized terms not often heard in everyday speech situations. Rather, in informal speech, the most common usage to refer to abortion is "rihno to pedhi". Literally, "rihno" means to 'throw', 'cast', or 'toss', and "pedhi'" means 'child'. Unlike more passive constructions such as 'to have an abortion', the sense conveyed by this common Greek usage is one of agency on the part of the woman. Similarly, the use of the word pedhi confers a personhood to the fetus that is consistent with the tenets of the Church, but offers no emotional insulation to the woman who aborts. In short, the ecclesiastical interpretation of the fetus as person appears uncontested. At the same time, the woman's active role in abortion is not euphemized or muted. How do women who have abortions reconcile these apparent contradictions? Furthermore, as childrearing "remains one of modern Europeans' [and Greeks'] most important symbolic activities" [5] what do the moral discourses used by these married women who abort reveal about how they wish to represent themselves to others? A helpful point of departure in understanding Rhodian women's moral discourses is Michael Herzfeld's discussion of the distinct and contrasting moralities exhibited by the rural Cretans he studied: a sense of sin in the ecclesiastical sense, and a socially-negotiated morality that is grounded first in accountability to other humans, and only secondly, in "sin in the eyes of God" [14,42]. Couched in an "idiom of self-exoneration", the latter appears to encompass primarily the illegal or ecclesiastically-defined immoral activities in which men in this sheep-herding society indulge (e.g. animal theft, blood vengeance). Women, in contrast, appear to be more concerned with the 'religious notion of original sin'. However, outside this rather unusual Cretan context, it is no doubt generally true that, as Amy Rushton [39] has noted, "of the major sins that must be confessed (infringements of the Ten Commandments) the only one to be committed with any frequency is committed by women". She is of course referring to abortion. Some women who aborted, like Niki, appeared to hold to a non-negotiable ecclesiastical sense of sin, even while repeatedly violating it. Thus, she explained, "It's forbidden by religion. Every time I regretted it, of course. But every time I had to do it". A majority of women, however, explained their abortions through an idiom of social morality, that is, a morality in which accountability to other humans, in this case, almost always the unborn child conceptualized as a potential family member, took first place. Moreover, this was a morality which was implicitly, and sometimes explicitly, critical of the ecclesiastical notion of sin. Thus, Katerina, a 27-yearold medical student, explained her abortion: "The Orthodox Church forbids it. And I revere it [the Church]. But beyond that, I believe there are other

Abortion policy and practice in Greece things too. If there are no prospects for keeping another child, how can you do it?" Koula, 40 years old and married to a bank manager, offered this explanation for her recent abortion, "it's wrong to bring a child into the world to go hungry". Was the abortion a sin, I asked? "It's a sin (amartia)", she replied, "but it's also a pity (amartia) to keep it, when you can't cope economically...I think God will understand". Had she had confessed her abortion to a priest? "No", Koula replied somewhat scornfully, "this is only between God and myself". In the following quote, Maria, whom I also cite earlier, reveals more elaborately the semantic slipperiness inherent in the way many women used the idiom of amartia : On the one side, it's an amartia [to abort], but on the other, it's also an amartia to raise a child who won't live under good circumstances, when you don't have the [economic] ease to raise them. That's an amartia, too. [In what sense of the word?]. Look, it's an amartia [emphatically], not to be able to give your child to eat. Better to take it out [abort], so that the child won't have to spend every day, not just with one arnartia on its back, but many. Here, Maria, adhering to a social morality in which 'sin" is tempered by, and in her case, inextricably commingled with, 'pity', refused to choose between the two senses of amartia. Maria's and Koula's deployment of this multivalent idiom can be interpreted as a strategic move toward self-exoneration that by-passes the formal institutions of the Church. Notably, neither felt they would be punished for their abortions: "I think God will understand". Also evident from these women's statements is the salience of 'hunger' as a justification for abortions. However, in the relatively prosperous Rhodian context, hunger was rarely a literal threat. As Koula, who was after all fairly well-off, clarified: "well, figuratively speaking. Of course, it wouldn't go hungry. But it wouldn't have all that my other two children have, the luxuries (politelies)--one pair of shoes, where my other children had three". Significantly, Herzfeld has also observed and analyzed the use of 'hunger' by rural Cretans as rhetorical strategy to negotiate the moral tensions inherent in animal theft [42]. Although their circumstances differ greatly, Rhodian women also seem to be deploying this venerable idiom (whose connotations, as Herzfeld notes, derive historical and emotional force from the Ottoman occupation, and from the hardship of recent wars) to negotiate the moral tensions inherent in their identities as Orthodox mothers who nonetheless abort. Through the idiom of 'hunger' both Rhodian women and Cretan sheepherders "can always represent their own position as one of moral advantage" [42]. The alternative socially-embedded morality articulated by many Rhodian women is akin to what Petchesky [7], speaking of the abortion decisions of women in the U.S., calls the "morality of praxis". Arising from the accumulation of women's lived experiences--including, importantly, the social and

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practical aspects of their reproductive experiences--it is a morality that gives greater weight to responsibilities to others and that, in the process, justifies and exonerates abortion. Feminist ethicists have also underscored the contextualized, relational considerations that go into U.S. women's deliberations about abortion [43]. Similarly, when Rhodian women speak of aborting 'the child', they are referring not to an abstract metaphysical notion of personhood, but to a potential member of their family to whom considerable obligations accrue. Yet, the logic of their decisions is embedded in, and inflected by, characteristically Greek idioms of moral discourse. While most Rhodian women continue to regard abortion as a sin, not fulfilling one's obligation as a mother and consigning a child to relative deprivation (to 'hunger') is perhaps a greater amartia: both a 'sin' and a 'pity'. CONCLUSION

In this article, I have examined abortion as a part of a Greek contraceptive culture which has taken shape during the postwar period both in response, and in resistance to, a variety of macro- and micropolitical institutions and forces. During this period. profound social and economic transformations have (in ways that have yet to be fully understood) prompted Greeks to dramatically limit their fertility. In a matter of a couple of generations or so, both the ideal and the reality of large families have been abandoned, as most couples adopt a pattern of 'early stopping' after just one or two children. As occurred in Europe's 'demographic transition' over the last century, much of this decline was due to 'traditional' techniques of controlling fertility, and coitus interruptus in particular. The Greek context differs, however, in that safe, medicalized abortions were an additional option, readily accessible first to urban women, who led the fertility decline, and eventually to others as well. An abundant supply of doctors and a widespread political culture of legal evasion created the conditions for this option. At the same time, the pronatalist policies and discourses of both state and church combined to foreclose most medical contraceptive alternatives. When the legalization of female methods finally occurred in 1980, it came at the end of a decade-long 'flight from the pill' and a barrage of negative experiences with the IUD in the U.S. and Europe. To further put this moment in context, just as Greek women began to have access to readily available information on contraception, Dutch women stopped taking the pill in large numbers [44]. Nonetheless, as I have argued in this article, Greek women's resistance to medical contraceptives was not only a consequence of fears rooted in an increasingly dominant biomedical paradigm, although this was certainly important. Resistance was also nourished by ethnomedical understandings of health and its maintenance. Part of a larger and influential discourse of social, moral and physical order, these

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alternative understandings in many cases were reinforced by women's experience, both direct and indirect, with the undesirable bodily effects of the two available medical methods. Given this conjuncture, abortion becomes a part of the experience of a near-majority of Greek women over the course of their reproductive lives. At the same time, it is an experience that with few exceptions occurs within a Greek Orthodox context that equates abortion with murder. To exonerate themselves from the absolutist equations of their church, but also to give acceptable meaning to their abortions, many women have rallied key cultural idioms in innovative and oppositional ways. Thus, when these women speak of the fetus as a 'child', it is not as an abstract person or soul in the ecclesiastical sense; rather, it is spoken of as a potential member of the family whom it is morally unacceptable, a 'sin' and a 'pity', to expose to deprivation and 'hunger'. In the process of affirming themselves as good mothers, they are also quietly and profoundly altering Greece's demographic regime. Acknowledgements--Research was funded by the American Council of Learned Societies, the Landes-RISM Foundation, and Rice University Faculty Research Awards. I am very grateful to these institutions for making this project possible. I also wish to thank Deanna Trakas and the Institute for Child Health for initial assistance in Athens and Rhodes, and for their continuing support. For their helpful suggestions at various stages of the writing, I thank James Faubion, Dimitra Madianou, Eleni Papagaroufali, Deanna Trakas, Leda Triadafilidou and the two anonymous reviewers. I am deeply grateful to Barbara Rylko-Bauer for her encouragement and suggestions.

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