Abstract
The 2012 election year has featured a protracted Republican-led “War on Women” seeking to undermine women’s rights. Next year, 2013, marks the fortieth anniversary of Roe v. Wade. These occasions make for particularly interesting times in which to consider the pro-woman activism and advocacy of the past, including that of feminism's second wave.
Three books provide a fine place to start. The first, Wendy Kline’s Bodies of Knowledge: Sexuality, Reproduction, and Women’s Health in the Second Wave uses five case studies to illustrate how feminists influenced health care in the 1970s and 1980s. Kline documents the lessons of the making of Our Bodies, Ourselves; the debate about how best to train doctors to perform pelvic examinations; and the 1983 Depo-Provera Food and Drug Administration (FDA) hearings, as well as the better known histories of the decriminalization of abortion and the rise of midwifery. Kline’s slim volume brims with information and insight, but so skillfully written that it never seems dense. Two other books, Rebecca M. Kluchin’s Fit to Be Tied: Sterilization and Reproductive Rights in America, 1950–1980 and Leslie J. Reagan’s Dangerous Pregnancies: Mothers, Disabilities, and Abortion in Modern America, present detailed histories of significant periods in the U.S. struggle for reproductive justice. In Fit to Be Tied, Kluchin examines the sterilization policies and practices that distinguished between the “fit” women, whose reproduction eugenic and neo-eugenicists sought to encourage, and the women who were deemed “unfit” by dint of race, ethnicity, or class, whose reproduction was actively devalued and, indeed, blamed for poverty, criminality, feeblemindedness, and other social ills. In describing the struggles for reproductive decision making, Kluchin helps us appreciate the “murky and flexible” boundary that exists between consent and coercion (p. 91).
Reagan’s Dangerous Pregnancies focuses on the German measles (rubella) epidemic in the United States in the early 1960s and the national anxiety it animated about reproduction, disability, and the “defective” child. German measles, Reagan observes, provides an occasion “to look again at some of our current policies and ideas about disabilities, pregnancy and abortion, informed consent, vaccines, and viruses by immersing ourselves at a point in time before children with disabilities were mainstreamed in public schools; before a visible, militant disability rights movement; and before movements for reproductive rights and justice” (p. 2).
Dangerous Pregnancies reflects a historian’s penchant for archival research; fully 129 of the book’s 372 pages are devoted to reference materials. Reagan is at her strongest when she steps back from the data and articulates insights that are grounded not only in her research but in her expert grasp of abortion politics. As but one example, she writes powerfully of the hazards of legislative attempts to separate the unborn from the pregnant women who sustain and support them. (Elsewhere, the material seems stretched to support a book-length project.)
The connections across the books are many, but I will briefly discuss three. I was struck first by the significance of scientific knowledge (and, in some cases, pseudoscience) in women’s reproductive lives and second, by the roles that ordinary women played in both advancing and challenging what we “know” about reproduction and how that knowledge has been put into practice. Reagan describes the collaboration among “media, mothers, and medicine” that facilitated the flow of scientific knowledge from the public to medical researchers and led to establishing the connection between maternal rubella and fetal and child outcomes. In Fit to Be Tied, Kluchin shows how eugenicists’ and neo-eugenicists’ pseudoscientific claims were used to justify coercive sterilizations for some women while other, typically White, women “struggled to gain access to sterilization and to overturn age/parity, spousal consent, and conscience clause policies” (p. 184).
Although, paternalism, racism, class bias, and religion often prevented women from accessing the medical information and health care they deserved, all three books show that women did not take the situation, well, “lying down.” Instead, they voiced their objections in classrooms and courtrooms, in letters to newspapers and hearings before the FDA, in interviews with the media, in lawsuits, and position papers, and in public demonstrations. Reagan credits White married, middle-class women who were grappling with the dilemmas of the German measles epidemic with making abortion respectable. Moreover, those women “also made respectful discussion of abortion possible and legal change urgent. As active citizens, they translated their needs into sophisticated lobbying, voting, and legal work” (p. 177). Kline’s Bodies of Knowledge powerfully illustrates women’s direct involvement in transforming women’s health care and creating knowledge about women’s bodies, and in wresting authority about female bodies away from the male medical establishment, a project that was aided by but did not end with the publication of Our Bodies, Ourselves. Kluchin devotes considerable attention to the women who “fought back,” including fascinating discussions of the lawsuits filed by women who were seeking the right to use sterilization as contraception (Operation Lawsuit), as well as those filed by women who were subjected to coercive sterilization.
The questions the authors raise about what we know and how that knowledge is reflected (or not) in practice remain relevant during feminism’s third wave. It seems that where women and pregnancy are concerned, science is too often ignored. Women continue to be arrested or otherwise deprived of liberty on the basis of false or exaggerated claims about drugs, pregnancy, and fetal and child welfare. Medical interventions that are routinely used during labor and delivery (such as the induction of labor, continuous fetal monitoring, and the restriction of food and water) persist despite the lack of evidence that these measures improve outcomes for mothers or babies. Many so-called crisis pregnancy centers remain in operation even though they rely heavily on misinformation and deceptive practices that are designed to trick and pressure women who seek abortions into continuing their pregnancies to term. Several states have laws and policies that require that a woman who is seeking an abortion receive information on accessing ultrasound services or undergo an ultrasound before an abortion, even though a routine ultrasound is not a medically necessary component of a first-trimester abortion and can add significantly to the cost of the procedure.
This point leads us to a third theme, namely, the role played by medical and social workers in undermining women’s reproductive rights to health, informed consent, accurate information, and competent medical care. In Fit to be Tied, Kluchin concludes that most physicians were guided by a misplaced paternalism, believing that sterilization would raise patients’ standard of living and improve their quality of life. At the same time, caseworkers and physicians alike were not above lying to women (such as by misrepresenting the nature or the permanence of the sterilization procedure), pressing them to be sterilized while they were still under the influence of pain medication or threatening to revoke their welfare benefits. Reagan describes how racial and religious differences between patients and doctors underpinned the power of physicians to shape women’s access to information, diagnosis, and medical care, including abortions. For example, Barbara Stewart, an African American woman, endured multiple gynecological examinations by male doctors she had never before met, each of whom insisted on confirming for himself the state of her pregnancy.
In other words, at some of the very points that women and girls would most benefit from support, advice, and compassion (i.e., when they are pregnant with an unwanted or unintended pregnancy, when they have contracted rubella or wish to terminate the pregnancy, or—as I have noted elsewhere—when they are the victims of violence, addicted to drugs, or have mental health problems), the responses of some members of the so-called helping professions have been paternalistic and patronizing at best and, at other times, downright callous, deceptive, and punitive.
As we consider the troubling state of contemporary affairs, we can gain much by the lessons—and the courage—of those who have striven for reproductive justice in the past. Any student of reproductive justice, social movements, or epistemology should plan to add these books to her library. Kline’s Bodies of Knowledge would work well with a wide range of students and in a wide range of courses; it is an excellent and engaging way to introduce students to the recent history of reproductive health care. Kluchin’s and Reagan’s books may be more appropriate for advanced students who are better equipped to appreciate the complex interplay among medicine, social welfare, and public health, as well as social inequality and public opinion. All three books offer cautionary tales about transforming private acts of reproduction into public health issues and the dangers of pseudoscience being put into service for classist, racist, and misogynist ends. Taken separately and together, these books provide powerful examples of how the medical profession and the state overstep or misinterpret their charge and the role of grassroots organizing and legal advocacy in bringing about needed social change.