Choice and Coercion: Birth Control, Sterilization, and Abortion in Public Health and Welfare.

Choice and Coercion: Birth Control, Sterilization, and Abortion in Public Health and Welfare. By Johanna Schoen. Gender and American Culture. (Chapel Hill and London: University of North Carolina Press, c. 2005. Pp. xviii, 331. Paper, 19.95, ISBN 0-8078-5585-5; cloth, $59.95, ISBN 0-8078-2919-6.)

Johanna Schoen sets out to give voice to women silenced by the power structure and to demonstrate that state policies could be used both to restrain women's reproduction and to extend women's reproductive options. She succeeds in achieving these goals. Schoen examines four groups involved in reproduction: medical and social science theorists; health and welfare professionals; state and county officials; and women who were targeted by and responded to reproductive policies. This book analyzes birth control, sterilization, and abortion policies in North Carolina. Schoen includes some national developments and case studies of Puerto Rico and India to demonstrate that North Carolina was not unique in its approach to reproductive care. She joins new scholars who emphasize women's agency in reproductive matters. While policies generally targeted poor and minority women, many women ignored the racial and class component of programs and used them to fulfill their own agenda, namely to control their reproduction.

This book makes several contributions to the literature. First, Schoen places reproductive polices within the larger framework of infant and maternal mortality and health care. Poor and minority women's lack of access to reproductive control was, she argues, "embedded in a context of inadequate social services and equally inadequate health care" (p. 243). Second, the author demonstrates that while many state welfare and health officials held demeaning attitudes toward clients, some officials showed genuine concern for women's rights and socioeconomic situations. Third, while historians have discussed how doctors stretched laws to perform therapeutic abortions, Schoen expands the framework to include therapeutic sterilization. Fourth, the author explains why many women willingly participated in trials for new reproductive products. Finally, she presents a picture of abortion in a rural area versus the usual urban context.

The strongest chapter is the analysis of sterilization. While the coercive side of sterilization has been discussed by historians, Schoen contributes a sophisticated analysis of the reasons some parents sought sterilization for their children and why some women sought sterilization for themselves. The author offers a nuanced study of the decline, or lack thereof as she argues, of eugenics. She contends that a eugenic mentality continues to influence reproductive policies today. In both this and the abortion chapter, Schoen rescues women's voices and describes the great lengths to which women went to secure desired procedures.

No book is perfect. While the author lays out the historical context for developments in North Carolina, she provides no corresponding historical context for her discussion of activists in Florida and Louisiana. In the analysis of birth control policies, Schoen treats the 1930s through the 1960s as one cohesive time period, using data from the 1960s to argue points relative to the 1930s. While women were overrepresented in eugenic sterilization programs nationwide, the gender discrepancy was much larger in North Carolina, but Schoen offers no explanation for this difference. In addition, she asserts that the law "did not forbid, permit, or regulate" sterilization but continues that the procedure was only legal if the pregnancy threatened the woman's health or life (p. 116). Lastly, readers will have difficulty believing that population growth in Puerto Rico threatened "the security of the world at large" (p. 198).

These minor issues aside, Schoen's book is a must read for anyone interested in reproductive issues. Her extensive use of manuscript collections, especially the North Carolina Eugenic Board's records, offers insight into numerous aspects of policy development. The reclamation of women's motivation in securing access to services, as well as the positive portrayal of some health and state officials, is a breath of fresh air. I highly recommend her book for classes on gender, women's, policy, or medical history.

SIMONE CARON

Wake Forest University