Birth Control

Birth Control

Planned Parenthood rally in Washington, D.C., April 7, 2011. Photo courtesy of the American Life League.

After Roe: The Lost History of the Abortion Debate
by Mary Ziegler
Harvard University Press, 2015, 400 pp.

Abortion after Roe
by Johanna Schoen
The University of North Carolina Press, 2015, 352 pp.

Forty-five years of uproar against abortion rights—who could have predicted this? The billions of dollars spent opposing abortion have helped build a right-wing political culture and forced many concerned with women’s and family welfare to forego agitation on other important issues. What a waste.

Some might think the controversy over abortion was inevitable, but that is not the way it seemed in the early 1970s when it began. By that time, the courts had overturned the last remaining statute prohibiting contraception for married couples, in Connecticut; eighteen other states were repealing or relaxing their century-old anti-abortion statutes; Gallup reported that 64 percent of Americans supported abortion rights before Roe v. Wade; the women’s movement was spreading to every small town in the United States; and even Protestant evangelicals supported birth control in general and the legalization of abortion in particular. Reproductive control seemed such a fundamental requirement of modern life, so necessary to low- and middle-income households, that few could imagine serious challenges to it. People of my generation had good reason to believe that this issue would be settled permanently.

Of course, the matter was not settled. Many factors explain the strength and longevity of the anti-abortion movement. Conservative Republican strategists used abortion as a means to break open the New Deal coalition—that is, to entice poor, working- and middle-class citizens to vote against their economic interests. They pumped massive funding into the anti-abortion movement. But to blame everything on this top-down force assumes that the public consists of easily duped fools. The campaign also changed beliefs, convincing many, especially the religious, that abortion constituted a particularly odious form of murder. The campaign succeeded not in reducing abortions but in making women who chose abortion feel guilty, or feel that they ought to feel guilty to reassure themselves that they were not evil, cold-hearted women. The campaign created what sociologists call a moral panic; but such panics are not usually sustained for decades. The unprecedented bifurcation of media and information in the last twenty years also contributed: pro- and anti-abortion rights people no longer take in the same information. The wall between, say, those who read the New York Times and those who watch Fox News, combined with social media–driven information silos, means that readers rarely encounter opposing views.

Meanwhile, the women’s liberation movement changed the meaning of abortion. By emphasizing reproduction control as a woman’s right, the movement made abortion rights part of a feminist agenda, not just a family planning necessity. As a result, abortion became, for religious conservatives, exhibit A in feminism’s plot to destroy the family. Then there’s the relationship between sex and abortion. Right-wing talk shows and social media feature tirades against women for their alleged promiscuity, arguing that the only people who need abortions are skanks and adulterers. These slurs renew a “slut-shaming” that has hounded women for centuries. They ignore the facts that the majority of aborting women are already mothers who cannot care for more children, and that the great majority of abortion decisions are made jointly by the women and men who produced the fetuses.

Even less imaginable in 1970, today some Protestant conservatives denounce even contraception and try to block access to it.

In this context, it might seem difficult to add any new information or analyses to the debate. But both Ziegler’s and Schoen’s books do. Ziegler shows the contingencies, shifts, and cross-cutting arguments in the strategies of both sides. Schoen offers a feminist medical history that leads to provocative criticisms of the mainstream “pro-choice” discourse.

Law professor Mary Ziegler uncovers some paths not taken, paths that might have bridged today’s political abyss between pro- and anti-abortion rights advocates. She challenges a common liberal narrative that sees “pro-life” activism as always part of an overall right-wing agenda. She examines, for example, an attempt at compromise based on destigmatizing unmarried pregnancies and births. By 1968 out-of-wedlock births had tripled over twenty-five years. Conservatives were campaigning against welfare and suggested that abortion access would provide one way to reduce welfare costs. (Some liberals used this argument too, though most feminists rejected it and supported instead the National Welfare Rights Organization’s call for a more generous welfare program.) Ziegler points to Marjory Mecklenburg, leader of a feminist anti-abortion group, who argued that reproductive freedom required respecting and aiding poor mothers, married or not, thereby echoing the demands of pro-abortion rights feminists. Her group also supported protecting women workers from discrimination when they are pregnant.

Another anti-abortion leader, Mildred Jefferson, an African-American surgeon who was president of the National Right to Life Committee, argued that Roe hurt women by leaving the power to prescribe an abortion in the hands of physicians, an argument made simultaneously by many feminists. Jefferson considered herself a “Lincoln Republican” and a feminist, and had supported anti-abortion Ellen McCormack’s campaign for the Democratic presidential nomination in 1976. As late as the 1980s, Planned Parenthood activists in Madison, Wisconsin (where I was then living), were meeting with anti-abortion rights activists to propose better state support for contraception and adoption as means of reducing the number of abortions.

Ziegler sees the early anti-abortion movement as multivalent and not inevitably glued to right-wing politics—that is, opposed to medical insurance, equal pay, minimum wage, medical research, and public education. Ziegler’s argument has some merit, but it ignores other influential factors aligning anti-abortion to the right: the Catholic hierarchy’s intransigence, which forced priests into line, even though Catholics use abortion proportionally more than Protestants; the increased political activism of Protestant evangelical preachers; and the threat to traditional “family values” attributed to feminism.

Ziegler also shows that it is the failure of the most radical anti-abortion agenda that put us where we are today. The inability of the anti-abortion movement to enact a constitutional amendment or to get the Supreme Court to reject Roe entirely forced it to adopt an incrementalist strategy. That, unfortunately, worked well. By imposing one limitation after another—banning public funds for abortion, requiring waiting periods and consent from parents and husbands, “protecting” women from “post-abortion syndrome” by requiring that they hear anti-abortion jeremiads, and enacting the “TRAP” (Targeted Regulation of Abortion Providers) laws that impose more burdensome requirements on abortion clinics than on other medical practices—the anti-choice movement has made abortions more expensive and more difficult to obtain, thereby delaying women’s access and pushing abortions into later stages of pregnancy.

These restrictions have grown despite the fact that public opinion about abortion has not significantly changed. Gallup says that in 1975, 22 percent of Americans wanted a ban on abortions; as of 2015 that proportion varies from 19 to 21 percent. Fifty percent label themselves “pro-choice,” 44 percent “pro-life.” That so many judges and state legislatures can disregard popular opinion reinforces the fact that anti-abortion policy is driven by right-wing politicians and funders who find the issue politically useful.

Johanna Schoen’s book is a medical history, and it is a first. (Her previous book exposed the coercive methods by which North Carolina sought to control reproduction among poor women and women of color.) It is also a master work of research. Schoen even joined the National Abortion Federation in order to discuss medical techniques with providers. The fact that such a medical history is only being written now is in itself a confirmation of one of Schoen’s important arguments: that the abortion rights movement has not always provided full and accurate medical information to the public. This is a challenging claim, one that the pro-abortion rights community needs to hear, but it also needs to be placed in context, because all social movement propaganda is constrained by the heat of its struggles.

Schoen proceeds by tracing clinical developments in abortion practice, including D and C (dilation and curettage) and aspiration techniques, fetal research, medical standards for abortion, viability determination, and D and E (dilation and evacuation) procedures for late abortions. She examines how these developments arose and, more importantly, how they were presented by both sides of the abortion controversy.

She begins the story with a too-often forgotten trial: the 1975 prosecution of Dr. Kenneth Edelin, then head resident, and later chief, of Boston University Medical School’s obstetrics and gynecology department. In 1973 he performed a second-trimester surgical abortion in which, prosecutors claimed, the fetus emerged “alive.” What constitutes a “living” fetus, and what that means in the context of a legal abortion, became central debates in the trial. Prosecutors also attacked the fetal research that had been conducted at Boston hospitals for decades. Schoen reminds us what that research yielded: vaccines, tests for genetic anomalies, life-saving techniques for premature births, diabetic treatments, bone marrow transplants, and more. None of this research had previously evoked opposition.

Newly available visual material also affected the Edelin case—photographic images of fetuses in the uterus and fetal parts in late abortions. (Political scientist Rosalind Petchesky first called our attention to the power of these visuals, especially ultrasound imaging, in a 1987 article.) Although routinely published in medical journals and textbooks, these photos shocked the Edelin jury, who then convicted him of manslaughter. Although overturned by the state Supreme Judicial Court a year later, the conviction sent a warning—the first in the series of attacks on abortion providers that drove hundreds to stop offering that service.

Edelin was African American, and racism played a considerable role in the trial. Schoen mentions this, but it deserves greater emphasis. The prosecution and trial took place in the midst of Boston’s violent resistance to school integration. The Boston School Committee repeatedly defied court orders for integration, and this ratcheted up an anti-busing hysteria that included not only sit-ins and demonstrations but even throwing rocks into school bus windows.

Schoen is particularly brave in discussing late-term abortion procedures. This material is crucial because the anti-choicers have convinced even some pro-choice people that third-trimester abortions can reasonably be banned. Here we meet the gruesomeness factor and its effective manipulation, as in the recent “exposé” of Planned Parenthood’s alleged “selling” of fetal tissue. Late-term abortion is a “sticky” issue, in Malcolm Gladwell’s sense of stickiness—how an image or a message adheres in a recipient’s consciousness. (This stickiness supports the moral panic theory about why anti-abortion efforts have been so successful.)

Until the late 1970s, most of the extremely rare third-trimester abortions were performed by instilling saline solution into the uterus, which induced labor; but these required several appointments, a great deal of pain, and the risk of complications (for example, if the saline entered the bloodstream). Schoen explains that the turn to dilation and evacuation (D and E) procedures produced greater safety and less bodily trauma. Both of two possible D and E procedures bring the potential for evoking disgust or moral condemnation: either an abortion provider removes a fetus by dismemberment—read, gruesome; or, in what is called intact D and E, she removes a fetus whole—read, possibility of a live birth and “murder.”

The gruesomeness factor could be transcended if the mass media featured thoughtful discussion. After all, as several physicians have had to remind us recently, medical workers deal every day with the gruesome, whether in surgery, in dermatology, in emergency rooms, or in Ebola clinics. Physician Leah Torres responded to the undercover videos of Planned Parenthood by pointing out that doctors need to discuss all sorts of gory procedures and cannot afford to waste time in euphemisms. Moreover, she writes, those working in “high-stress professions . . . firefighters, trauma surgeons, fighter jet pilots, and others will often use dark humor in order to cope with the emotionally draining aspects of their jobs.” As to the charge of “selling” fetal tissue, which Planned Parenthood never does, all sorts of body parts are sold regularly: ova, sperm, kidneys, blood, hair; while uteruses are frequently rented in surrogacy procedures.

Regarding intact D and Es, the charge of “murder” rests on a logical contradiction: if an abortion is legal, then of course the fetus is destroyed. Schoen believes it dishonest to pretend otherwise, whether you call it murder or not.

But abortion rights organizations, Schoen shows, consistently refused to explain or debate the facts about D and Es. They often sugar-coated these abortions—minimizing the pain and shielding the public from full knowledge of what they involve. This behavior in some ways continues a practice of “protecting” women from facts about their health, a practice that continued well into the 1970s. Many physicians then routinely withheld the facts about serious medical problems from female patients and instead informed their husbands, on the grounds that women would be too hysterical to cope with the knowledge or to adhere to treatment; or, if doctors lacked respectable middle-class men to inform, they might withhold bad news entirely, in the belief that it would interfere with healing or life expectancy. The abortion rights movement, Schoen charges, sometimes encouraged abortion providers to withhold information. So when one physician publicly admitted lying about D and E’s, he became the object of media coverage that strengthened the anti-choice movement. Abortion-rights defenders were committing, in short, a cover-up, not of a crime, but of a legal medical procedure. “You cannot let pictures of this on the floor of Congress,” one warned.

The abortion-rights lobby also evaded moral questions, Schoen charges. One could argue that they were unwilling to stand by the premise that women have the capacity and the right to make their own moral decisions on behalf of themselves and their families. Spokespeople for abortion rights frequently claimed that intact D and E’s were performed only in cases of severe fetal abnormalities. The mainstream liberal media, Schoen reports, often adopted “the official statements of national pro-choice organizations as proven facts.” To the contrary, the majority of the very small number of intact D and E’s are “performed for elective reasons, on healthy women and healthy fetuses.” This is because typical D and E patients are those who delayed making decisions about their pregnancies: teenagers, women on Medicaid who had to beg or borrow money to pay for an abortion, obese women, women too scared to tell others they are pregnant, women so terrified that they deny their own pregnancies, women with chaotic lives. In prettifying D and E procedures, the pro-choice movement may have let down their most needy constituents for fear they would appear “undeserving.” I think of the three desperate and distraught New York City women who, in 2015 alone, threw infants out of windows to their deaths, and I wonder whether a late-term abortion would have helped them.

Schoen’s challenge will not be easily met. Of course campaigners for any sorts of rights should weigh the costs of fudging the facts, and the long-term advantages of discussing uncomfortable truths. But before condemning abortion-rights activists, consider that many organizations prefer not to publicize gory pictures: we don’t see images of gunshot wounds or body parts of soldiers blown up by explosives—or, for that matter, the effects of anti-abortion violence. Since 1973 anti-abortion advocates have murdered eight providers and committed seventeen attempted murders, 6,800 acts of violence—arson, bombings, assaults, threats—and more than 188,000 acts of disruption, not counting the November 2015 terrorist attack at the Colorado Springs Planned Parenthood clinic. Campaigns like that for abortion rights, especially when on the defensive, do not often have the luxury of protracted deliberation in responding to hysterical accusations. However much the pro-choice groups soft-pedaled the facts, their distortions were minor compared to the outright lies told by the other side (for example, that abortion causes breast cancer and prevents further childbearing). I am not sure I would have done better had I been on the front lines of defending reproductive rights.

Meanwhile, abortion-rights advocates can hardly be blamed for their failure to bring together pro- and anti-abortion rights people. Since no one thinks abortions are the best means of birth control, we can understand why compromise seemed appealing. Perhaps joint recommendations for reducing the abortion rate could occur when contraception is easily accessible to everyone, and when our population is no longer so vulnerable to the right-wing charges that feminism and sexual freedom will destroy our society.


Linda Gordon teaches history at NYU. She has written about the history of reproduction control in The Moral Property of Women: A History of Birth Control Politics in America (University of Illinois Press, 2002). Her most recent book is Feminism Unfinished: A Short, Surprising History of American Women’s Movements (Liveright, 2015).