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Reproductive rights as they are now.

Crow After Roe: How "Separate But Equal" Has Become the New Standard in Women's Health and How We Can Change That

By Robin Marry and Jessica Mason Pieklo

Brooklyn, New York: Ig Publishing, 2013, 224 pp, $16.95, paperback

Generation Roe: Inside the Future of the Pro-Choice Movement

By Sarah Erdreich

New York: Seven Stories Press. 2013, 272 pp., $16.95 paperback

Reproductive Politics: What Everyone Needs to Know

By Rickie Solinger

New York: Oxford University Press, 2013. 240 pp., $16.95 paperback

In its inaugural issue in 1972, Ms. Magazine published a petition signed by 53 prominent women declaring, "we had abortions" and calling for "repeal of archaic and inhumane laws." The following year, the Supreme Court issued its riding in Roe v. Wade, legalizing abortion. Forty years later, the issue of abortion is still politically charged, although the conversation has shifted (for now) from legality to access and respect. In other words, in just over four decades, the nation has moved from the coat-hanger to the transvaginal probe.

Focusing on recent state-imposed and court-supported barriers to abortion, Robin Marty and Jessica Mason Pieklo have chosen an apt title for their book. Crow After Roe draws a parallel between the Jim Crow laws that enforced racial inequality to women's unequal access to abortion. They describe the disparate impact measures limiting access have had on the reproductive choices of poor women, young women, women of color, women living in rural communities, and women residing in states controlled by antichoice legislatures. Just as Jim Crow laws operated locally, not nationally, so does antichoice legislation.

Crow After Roe recounts the passage of abortion restrictions in the states and their implications for women seeking abortions, and analyzes the court rulings that have upheld most, but not all, of these laws. The passage of state laws restricting access to abortion, the authors make clear, is viewed by antichoice activists as a stepping stone to toppling Roe v. Wade. As part of this incremental strategy, antichoice campaigners have promoted legislation that narrows access to medical abortions (in which an abortifacient drug, such as RU486, is used rather than surgery); requires minors to notify parents and obtain their consent; establishes insurance and licensing mandates that limit the number of providers; subjects women to criminal liabilities for pregnancies that end badly (due to suicide attempts or failure to obtain medical help, for example); requires women seeking abortions to view fetal ultrasounds; and forces physicians to provide prospective patients with information that has no scientific basis. Such legislation increases costs, pushes physicians and clinics out of business by over-regulation, and scares and stigmatizes women who have abortions.

Federal laws and Supreme Court rulings have emboldened antichoice activists and sustained their state legislative efforts. The authors briefly discuss the Hyde Amendment, first passed in 1976, that bars the use of federal funds for abortion, except when a woman's life is in danger or in cases of rape or incest. The significance of the Supreme Court's ruling in Planned Parenthood of Southeastern Pennsylvania v. Casey (1991) is made clear. This ruling created an "undue burden" standard, defined as a "substantial obstacle in the path of a woman seeking an abortion before the fetus attains viability." This newly created standard made it far easier to restrict access to abortions, and using it, the Supreme Court in Gonzales v. Carhart (2006) upheld the 2003 Partial-Birth Abortion Ban Act. Because of this decision, a physician might believe an intact dilation and extraction (the medical name of the procedure banned by the act) would be best for a patient, but would have to follow the congressional guideline.

Crow After Roe concludes with a spirited call for the election of prochoice candidates at every level of government, for an aggressive effort to propose and enact laws that support women's reproductive autonomy, and for attention to judicial elections and appointments. It mentions a bill in California that would have allowed nurses, nurse midwives, and physician's assistants to provide first-trimester, surgical abortions. The bill went nowhere, but its author, state senator Christine Kehoe, and other activists raise an important question--why can't lots of health care providers be trained to offer this safe, in-demand procedure? At least California managed to enact a law allowing registered nurses, nurse midwives, and nurse practitioners to prescribe birth control.

Sarah Erdreich's Generation Roe is also a call to action. It is infused with the personal stories of those who put their lives on the line to provide abortions, and it pays homage to those who lost their lives or were badly injured in attacks on reproductive health clinics. The book provides a statistical portrait of abortion in the United States, noting the number of counties with no abortion providers and the declining number of providers overall. It reports that, despite the many obstacles to obtaining an abortion, three in ten American women will have one before the age of 45. Erdreich reads the blogs; she talks with women who have had abortions and the physicians and clinic directors who serve them; and she critiques television presentations about abortion. Her interviews, like one with a medical student, who says "Until I actually got involved in Planned Parenthood, I don't think I recognized what the limitations were for women seeking abortion. I just assumed abortion was legal, anybody could have an abortion if they needed it." Erdreich shows why this is both wrong and so often thought to be the case.

Out of curiosity she attends a Right to Life march to hear speakers offer the common rallying cries comparing abortion to the Holocaust and equating embryos and fetuses with children. When she becomes pregnant, she visits a so-called crisis pregnancy clinic to learn how these institutions, which exist to dissuade patients from having abortions, operate. The experience proves to be less dramatic than she'd hoped, having girded herself for an anti-abortion lecture steeped in religion. She recognizes that the clinic generally works with poor, single women and girls of color; and that "as a married, white, adult woman who didn't mention finances as a pressing concern," she "didn't fit the profile." However, when she reads the pamphlets she's been handed, she realizes how much inaccurate information the clinic was conveying to its visitors, such as claiming that abortion made women infertile and was linked to breast cancer.

The question at the heart of Erdreich's book is this: why, if there are more than 1 million abortions in the United States every year, are we not talking about abortion as a common, safe medical procedure? She wonders what would happen if abortion were "normalized"--talked about as frequently as it is considered or performed. We know all about the elective cosmetic surgeries of celebrities, says Erdreich. Why don't we know about the abortions of our friends, family, neighbors, and co-workers? Why the silence?

Erdreich believes the problem lies with the antichoice movement's seizure of the rhetoric, transforming the discussion from one about women's rights to one about fetal rights. But she blames activists as well, discussing the divide between grassroots organizations that bring together young activists ready to confront political opponents and established, better-funded, hierarchical organizations that focus on lobbying and court challenges. The new activists want to step forward and speak; the older organizations seem to want only designated spokespeople before the cameras. Can they unite their energy and resources and expand their power, she wonders, sharing the stage and agreeing that engagement takes many forms? Should the movement turn from hoping to win support from politicians and their parties to encouraging a public conversation about abortion that draws in political allies who see the wisdom of appealing to the majority of voters? Can the movement acknowledge the range of responses of women who chose to have abortions, eschewing slogans and embracing the complexity of women's choices? She does not give us answers.

Generation Roe is a work of political passion; its power lies in the voices (including her own) that Erdreich presents to the reader rather than in the depth of its analysis. She is generous in acknowledging the scholars whose works she relies on and she offers a resource list of organizations, books, films, and blogs for those who want to delve into subjects she presents in a few brief paragraphs. Marty and Pieklo's account of the success of aggressive efforts to roll back abortion rights leaves the reader with a sense of doom, while Erdreich's book is energizing. Unfortunately, however, Erdreich's optimism seems unfounded, given recent history. Perhaps a new day is dawning, and the small victories among the many losses really do herald a better future--but Erdreich presents little evidence that this is the case.

Neither Crow After Roe nor Generation Roe addresses the financial cost of battles to keep abortion legal, accessible, and affordable. How much money do reproductive rights groups spend on monitoring legislative initiatives and fighting bad bills in state legislatures? How much do they have to put into getting anti-abortion legislation overturned by the courts? What about campaigns for prochoice elected officials and for public education? The economics of abortion politics is outside the scope of these works, but it is worth considering, and hopefully these authors and others will address this question in future works. When we talk about abortion, we have to talk about money.

We also have to place discussions of abortion within a larger analysis of reproductive politics, says Rickie Solinger. Using a simple question-and-answer format, Reproductive Politics takes up a number of issues she views as critical, albeit in brief. She begins by defining reproductive politics as involving issues related to contraception, abortion, sterilization, adoption and sexuality, and discusses how sex and reproduction are both public and private matters. She looks at history, feminism, law, religion, population control, public policy, teenage pregnancy, single motherhood, debates about values, and contraception. The portion of her book dealing with abortion is divided into three sections: opinions and science; experience and practice; and activism, law, and policy. Within these categories, she examines reproductive technologies, adoption, the environment, disability, birthing, breast-feeding, the role of men, and global health issues. The book is a compendium of issues linked to reproductive politics; it is not designed for readers seeking an examination of the fundamental political divisions between those who support and those who oppose women's reproductive rights. She leaves the reader with some basic knowledge and a good list of resources. This book, unlike the other two under review, has an index, making it an easy-to-use reference tool. Whether it truly supplies "what everyone needs to know" depends on how deeply the reader wants to explore particular issues.

Solinger is at her best exploring the historical roots of contemporary dilemmas. In a chapter on the fetus, she explains that during what she calls "the illegal abortion era," (from the midnineteenth century until the Roe decision) the fetus was not the locus of concern. Abortion opponents focused on protecting women from dangerous substances and procedures, and they emphasized the consequences of extramarital sexual activity. Without access to abortion to cover up illicit pregnancies, they presumed that both women and men would refrain from "immoral" behavior. Anti-abortion leaders also worried about the falling birthrate of white Protestant women at a time when births to immigrants and their offspring were increasing. They wanted to families of the "right stock" to bear more children rather than to limit their fertility.

Concerns about the fetus came later, beginning in the 1920s, with laws that were intended to protect the fetus by prohibiting women from undertaking certain kinds of work. This was followed by the assertion of "fetal rights" by those arguing for court-ordered medical interventions on pregnant women; recent efforts to remove women from certain workplaces or jobs by employers leery of exposing pregnant workers to dangerous substances; and by prosecutors charging women with fetal abuse for the ingestion of illegal drugs during pregnancy. Over the past forty years, the balance has tipped even further from a discussion of women's reproductive rights to one about fetuses.

Despite its question-and-answer format, Reproductive Politics often presents dilemmas rather than solutions. When a pregnant woman undergoes prenatal genetic testing, learns that her fetus may be disabled, and then chooses to abort, she is making an individual decision that should be respected. Right? But drawing on the work of disability activists, Solinger points out that this kind of decision has consequences, including the potential isolation and stigmatization of disabled people. Solinger pays the same careful attention to social and individual costs and benefits when she examines international adoption and what she terms "values debates," which include discussions of abstinence-only sex education, gay and lesbian parenting, and "conscience clauses" that permit healthcare providers to refuse to offer services that conflict with their religious or moral beliefs. Still, for all her efforts to present issues from multiple perspectives, it is clear that Solinger believes that individual reproductive rights are fundamental human rights, and that she finds troubling those who attempt to limit these rights and to privilege fetuses over pregnant women.

Since these books appeared, additional legislation designed to restrict access to abortion has been proposed, enacted, and brought into the courtroom. Gubernatorial elections are looming in two states, New Jersey and Virginia, in 2013, and both federal and state elections will follow in 2014. Full implementation of the Affordable Care Act is on the horizon, meaning that more women will have access to health coverage, including contraception and maternity services (although the act maintains the status quo in denying federal support for abortion services). We can therefore expect more books about abortion and reproductive politics in the coming years, and we will be able to see whether they offer solutions to the predictions, hopes, demands, and quandaries presented in these accounts. Each has something to offer, and taken together they provide an instructive tableau of our current situation, with abortion rights threatened at the state level, Supreme Court support diminishing, more than 1 million abortions occurring annually, and a majority of Americans supporting the legality of abortion. Stay tuned. Changes may be coming, and all of these authors will likely be writing revised editions.

Reviewed by Janet Golden

Janet Golden is professor of History at Rutgers University, Camden, and the author of numerous books and articles on the history of women, children, and health care in the United States.
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Title Annotation:'Crow After Roe: How ''Separate But Equal'' Has Become the New Standard in Women's Health and How We Can Change That,' 'Generation Roe: Inside the Future of the Pro-Choice Movement' and 'Reproductive Politics: What Everyone Needs to Know'
Author:Golden, Janet
Publication:The Women's Review of Books
Article Type:Book review
Date:Sep 1, 2013
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