Ignoring the elephant.

Safe, Legal, and Unavailable? Abortion Politics in the United States Melody Rose (CQ Press, 2007, 235pp) 978-1933116891, $28.99

"Roe v. Wade is hardly the radical, abortion-on-demand ruling that it has been portrayed as in recent years."

MELODY ROSE WROTE Safe, Legal and Unavailable? in response to the popular misconception that abortion is or ever has been "available on demand." She raises an excellent point, which holds true for the groups that she labels prochoice and prolife. The prolife contingent still holds Roe up as the bedrock of abortion rights at which to chip away. Likewise, a rally in support of abortion rights will undoubtedly be festooned with signs proclaiming the need to "SAVE ROE," implying that the decision is the gold standard for safe and unobstructed access to abortion.

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As Rose shows, while Roe remains a talisman for both camps, law, policy and politics have evolved in the intervening 34 years to greatly influence women's access to abortion. She wrote this book as a textbook on the development of abortion policy; the end of each chapter includes discussion questions and further reading. The discussion questions are exceptionally thought-provoking, not just for sparking dialogue between people who may not agree on the issues, but for forcing readers to confront and question their own long-held beliefs.

The book's major shortcoming is its failure to address forthrightly the role of morality and religion, and more specifically sexual mores, in the development of abortion politics and policy. The author promises an exploration of the development of public policy on issues that "are the stuff of 'gut' politics." She acknowledges that religion and morality are integral to the development of such politics, but does not consistently show how these crucial factors have shaped law, policy or public opinion. Rose provides interesting polling data indicating that the public thinks that there are "justifiable" reasons for abortion--namely rape and incest. However, she does not address the clear moral judgments regarding women's sexuality underlying this view: that a woman who has sex willingly has a harder time justifying her decision.

On the positive side, Rose displays awareness that the decision to terminate a pregnancy is an expression of a woman's moral agency. She notes that in one study, "women chose to have the procedure because of the sense of responsibility toward the other people and commitments in their lives, contrary to the perception held by some that women make this decision lightly."

The reader would have been better served had Rose further explored how cultural views toward sexuality and women's roles in society have influenced abortion policy. The general empathy afforded to rape survivors seeking abortions stands in stark contrast to beliefs regarding other women who terminate. Rose notes that there is a pervasive myth that women--those who presumably had sex willingly and are therefore in some way morally deficient--make this decision without giving it adequate thought. This is the impetus for waiting periods. If there had been a consensus that women were motivated by their capacity as moral actors, it is likely that abortion policy would have evolved in a very different way. In discussing the factors that contribute to the development of policy, Rose should have drawn out these linkages, especially since she is presuming the reader is relatively new to the issues.

ROSE IS ON HER STRONGEST footing when addressing the development of the case law on abortion rights, beginning with Roe and continuing to the most recently decided cases, Gonzales v. Carhart and Gonzales v. Planned Parenthood. Rose provides summaries of the cases and walks the reader through the restrictions at issue. This section provides a fair amount of analysis of the Supreme Court holdings and how the Court balances the various interests implicated in the abortion decision: the state's interest in potential life, the woman's interest in her life and liberty, and the interest most often forgotten, that of the medical profession.

Rose highlights the shift in the balancing of these interests. With current policy debates and rhetoric primarily focused on the respective rights of the woman and the fetus, the book reminds us that the early cases emphasized the interests and rights of the medical profession. Unfortunately, although Rose touches briefly on the religious and moral shifts giving rise to the Court outcomes, she never squarely provides the social and political contexts that influenced these cases.

Rose ably describes how Roe's grounding in the right to privacy ultimately left states free to impose restrictions that have resulted in serious limitations on abortion access. This is most vividly illustrated by the Supreme Court's abortion-funding cases, which held that states and the federal government could exclude abortion from coverage under medical programs for the poor. (For a thorough commentary on how the Court could have tailored the opinion to better bolster the right, see What Roe v. Wade Should Have Said, Jack Balkin, ed. [New York University Press, 2005].)

Rose also notes the obvious hypocrisy of limiting abortion access yet denying social services to children, and she touches on the social and political underpinnings leading up to so-called welfare reform in 1996. But it should also be noted that the organizations of the religious right cited by Rose were very vocal regarding an alleged decline in "moral values" and supported specific policies to encourage what they viewed as moral behavior. Provisions that sought to limit or punish out-of wedlock childbearing and encourage marriage were intended to control what some viewed as the source of society's ills--women's unfettered sexuality.

CHARTING THE DEMISE OF ABORTION as a right, Rose examines Webster v. Planned Parenthood, in which the Supreme Court said states could regulate abortion access throughout pregnancy and impose barriers that express a preference for childbirth, rather than approaching abortion as a medical procedure. Rose goes on to track the transition from right to privilege through Casey, in which the standard was further lowered to allow for any abortion regulation that did not present an "undue burden" on the woman's decision.

Optimistically, Rose reminds us that Casey still supports the basic premise that a state cannot undermine women's health in its attempt to protect an interest in the fetus. Unfortunately, her optimism was unfounded. In Gonzales v. Carhart, decided after the publication of Rose's book, the Court allowed states to criminalize intact dilation and extraction, which in some circumstances could be the safest procedure for a given woman, and thereby rejected the primacy of women's health in abortion jurisprudence. The case also created new state interests in restricting abortion, including protecting "the bond of love the mother has for her child" and the reputation of the medical profession, which the Court presumed is harmed by the existence of the procedure at issue. The case will undoubtedly give rise to a host of new restrictions, further ensuring that abortion is anything but "available on demand."

Readers should be cautioned: Some sections of this book contain factual errors and statements that will be confusing or misleading to a non-lawyer or anyone unfamiliar with the subject. In particular, Rose:

* Implies that pharmacists can dispense RU-486, even though in fact, only doctors can get the drug from the manufacturer and dispense it to patients.

* Implies that some states generally require emergency contraception (EC) to be dispensed. Rose is apparently referring to laws that require emergency rooms to give or inform rape victims about EC, or laws and regulations that allow pharmacists to dispense EC directly to patients without a doctor's prescription.

* Implies that EC works by preventing the implantation of a fertilized egg in the uterus. Recent evidence establishes that it is far more likely that it prevents ovulation or fertilization.

* Incorrectly states that an administrative provision expanding coverage under the State Child Health Insurance Program to "unborn children" of non-citizens fails to provide prenatal coverage for the women. This is exactly what the provision does.

* Implies too broadly that one can get an abortion only at a hospital in some states. Some states do require that some abortions be performed in hospitals, but the requirement applies only after a certain period of gestation.

* Incorrectly states that the Abortion Non-Discrimination Act has never made it out of committee in the Senate, when in fact the act was passed and signed into law in December 2004.

* Incorrectly states that the Hyde Amendment provides abortion coverage for women on Medicaid only when their lives are endangered. In fact, the current version requires coverage in cases of pregnancy resulting from rape and incest as well.

JILL MORRISON is senior counsel at the National Women's Law Center, a Washington, D.C.-based, organization that has been central to several landmark legal and public policy initiatives to improve the lives of women, girls and families since 1972.