Birth control politics throughout most of the twentieth century in America have been laced with a tension between the ideas and methods of popular organizers and mass movements on the one hand and those of liberal reformers and sympathetic medical and legal professionals on the other. "Abortion on demand" and "a woman’s right to control over her body" were never ideas that carried much weight in family planning conferences and AMA committees, in the legislative hearings and courtrooms where abortion policy was made, even though those ideas created important pressures on clinicians and policy makers to find more "moderate" principles to accommodate women’s demands. Among such ac — commodationist principles the most important was the legitimacy of "therapeutic" abortion. This is the concept that the conditions justifying abortion are those that involve a woman’s health, though "health" may be broadly defined to include a woman’s mental or emotional health as well as fetal health. Those exclusively qualified to determine when such conditions, or "medical indications," exist, and to administer the procedures, are certified physicians.
Feminists have strongly opposed the distinction between therapeutic ("necessary") and elective ("unnecessary"?) abortions. Ellen Willis recalls this debate during the campaign for legalization in the late 1960s:
When the radical feminist campaign for repeal of the abortion laws began in 1969, our first target was the "reformers" who sat around splitting hairs over how sick or poor or multiparous a pregnant woman had to be to deserve exemption from reproductive duty. It was the feminist demand for the unconditional right to abortion that galvanized women and created effective pressure for legalization. Now the idea that abortions without some special justification are not necessary but merely "convenient"—as if unwanted pregnancy were an annoyance comparable to, say, standing in a long line at the supermarket—has been revived with a vengeance.54
Radical and socialist feminists, working through organizations such as the Chicago Women’s Liberation Union, NOW, Redstockings, and women’s health activist groups, consciously rejected both the medical model of reproductive health and (though not always) populationist goals as the basis of birth control. In contrast to family planners and public health practitioners, feminists put forward a libertarian view of "abortion on demand" as a necessary condition of women’s right to control their bodies and pregnancy:
All the excellent supporting reasons—improved health, lower birth and death rates, freer medical practice, the separation of church and state, happier families, sexual privacy, lower welfare expenditures—are only embroidery on the basic fabric: womans right to limit her own reproduction. It is this rationale that the new woman’s movement has done so much to bring to the fore. Those who caution us to play down the women’s rights argument are only trying to put off the inevitable day when the society must face and eradicate the misogynistic roots of the present situation. And anyone who has spoken publicly about abortion from the feminist point of view knows all too well that it is feminism— not abortion—that is the really disturbing idea.55
Contrasting "reform" to the more radical demand for repeal, feminists argued that the former was steeped in conditions that denied women’s capacity and right to make reproductive decisions. Medical and legalistic models of abortion, they pointed out, focused on "hardship" situations— rubella, rape, mental illness—and thus "always pictured women as victims, . . . never as possible shapers of their own destinies."56 And these models implicitly suggested that women were incompetent to act as moral agents on their own behalf. Repeal, on the other hand, would simply abolish any restrictive, discriminatory conditions impeding abortion so that medical authorities could no longer be moral gatekeepers.
Legal abortions had always been possible in some states to save a woman’s life or spare her "serious" health problems, or for the other classic "hard" reasons: the fetus was known to be defective or the pregnancy resulted from rape or incest. But to obtain an abortion even under these conditions involved going through hospital committees and private networks that were penetrable only to privileged women. When the laws of some states underwent reform in the late 1960s, these restrictive conditions continued and, if anything, became more apparent under the rubric of (now legal)"therapeutic" abortions. Punitive therapeutic abortion committees put women through intense and often moralizing inquiries to determine whether their abortion request was truly justified on »health" grounds. Physicians and hospital authorities in California and Colorado, for example, imposed enormous red tape, requiring written consent from at least two physicians as well as the hospital committee and insisting on inpatient (hence much costlier) procedures. Many hospitals, particularly smaller ones, feared the label "abortion mill" or had chiefs of service opposed to abortion; thus they refused to perform abortions or imposed strict residency requirements.57 These restrictions effectively excluded poor women, who lacked the personal connections to private doctors and the funds necessary to obtain a safe hospital abortion.
In the radical political context that existed from 1968 through the early 1970s, however, feminists and other proabortion activists sometimes found it possible to use "health" and "mental health" provisions expansively, to push them to their limits. Abortion referral groups in California, for example, were able to use "psychiatric indications" to sidestep much of the red tape that encumbered hospital abortions—evidently finding cooperative physicians with less difficulty—and thus to process most abortion cases.58 Along with abortion activists in progressive church groups and radical health groups, civil libertarians, and some sympathetic doctors, organized feminists functioned as shock troops in the struggle to break through legal barriers. By pushing at the soft spots in existing laws (utilizing "health" and "mental health" provisions, testing hospital rules), they were able to open a wedge through which the growing need of women for access to abortion services could make itself felt even among the most resistant physicians.59
These tactics affected only a small number of women and were really test cases. The most important action feminists took to expand women’s access to abortion and change the medical profession’s position was through providing information and a network of alternative—and in at least one case, underground—services. Popular feminist pamphlets published from 1969 to 1971, especially The Birth Control Handbook and the now classic Our Bodies, Ourselves, circulated in the many thousands of copies, giving practical information about abortion procedures, risks, and sources of information and service.60 As in the early twentieth century, alternative clinics and a network of cooperating private doctors were set up in the vacuum created by the institutionalized medical profession’s refusal to provide care even after liberal abortion laws were passed.
In New York, for example, after the state passed one of the most permissive laws in the country in 1970, state health officials immediately tried to implement "guidelines" that, contrary to the law’s spirit, once again would restrict abortions to "accredited hospitals and their clinics."
Despite the new law, hospitals continued to refuse abortion services to women past the first trimester, or from out of the hospital catchment area, or without either ready cash or insurance coverage. In the face of such roadblocks, feminists and other abortion activists set up their own alternatives: an abortion "underground" that provided counseling and referrals to safe, reliable practitioners; and eventually, a national network of freestanding abortion clinics. Members of the medical hierarchy have consistently opposed such clinics, have refused to cooperate with them, and have ostracized gynecologists who did. The reality is that the clinics have provided more and better abortion services, with significantly lower complication rates, more attention to counseling and birth control, and at much lower cost, than have the nation’s hospitals.61
Politically, the impact of confronting the medical profession and the state with a rival set of institutions that could clearly meet people’s needs, and do so at a lower cost, was powerful. More than anything else, it illustrated that the criminal statutes could not be enforced. Feminists believed—and they were not altogether wrong—that new abortion techniques, when used early in a pregnancy and under safe conditions, were so simple they could be "seized" from medical control.62 Indeed, it is ironic to speculate that the fact of abortion’s technical simplicity and lack of "heroic" surgical challenge is one reason why many doctors disdain it. Acting on this belief, at least one group of feminists set up an underground abortion clinic in Chicago that operated over a four-year period (1969-73) practically under the eyes of the police, providing eleven thousand illegal abortions.
Known as Jane and originating out of the Chicago Women’s Liberation Union, the clinic delivered services to women of all ages and stages of pregnancy. At first it contracted with illegal abortionists, trying to bargain down their fees, but then Jane volunteers learned to perform the operation themselves, using the aspiration technique, which made it possible to reduce fees to an average of $50, although "no one was turned away for lack of funds."63 In this way, the theory and practice of self-help became an essential part of the struggle for legal abortion, proving "that abortions could be performed safely, humanely and very inexpensively by non-professional paramedics working in apartments." Jane maintained a safety record that compared "favorably with that of licensed medical facilities in New York and California" in the early years of legal abortion, and it was able to provide its services primarily to low-income women. It not only monitored clients’ reproductive health (through Pap smears, taking blood pressure, referrals for complications) but focused on counseling as "the heart of the procedure"—a form of counseling that attempted to give the woman sisterly support and to demystify the abortion experience.64
In part, the threat posed by Jane and the freestanding (legal) clinics that succeeded it was economic. Low fees made ‘The bottom fall out of the abortion black market/’ hence undercutting what had long been a boondoggle for some doctors.65 Even more important, the fact that these clinics provided (and continue to provide) a vital service that thousands of women desperately need, under safe conditions, has been the major determinant of their "unstoppability." It is interesting that in four years of illegal operation involving dozens of activists, only seven members of Jane were arrested; the charges were dropped in 1973. "The police were not interested in stopping them, . . . the police had known what they were doing and had not intervened. . . since they were providing a necessary service for policemen’s wives, mistresses and daughters and for all policewomen," and did so in a manner that left women healthy and well rather than bloody or dying.66
From 1968 to 1973, the organized feminist movement used a variety of direct-action methods to put pressure on the medical profession, state legislatures, and popular consciousness to repeal abortion laws. The 1969 AM A Convention in New York was surrounded by picketers from the women’s movement wielding signs and leaflets "demanding that doctors sign a petition for repeal."67 Feminists from NOW and other women’s liberation groups invaded the AMA meeting, as well as courtrooms, legislative hearing rooms, district attorneys’ offices, and the streets—no bastion of patriarchy was sacrosanct—and provided the most visible external pressure for change in the abortion laws. Joined by radical health and welfare rights groups, they sat-in at public hospitals and health agencies to demand that abortion services be provided to poor women. Redstockings (a New York women’s liberation group) sponsored a "speakout on abortion" at which dozens of women testified publicly about the horrors of their illegal abortions.68
The shift in medical and family planning policy from 1969 to 1971 was a response to this political pressure, as well as to the threatened growth of alternative abortion services outside the control of the medical hierarchy. These two factors—the militant organizing of feminists and the threat of "alternative services"—were crucial political influences toward loosening population establishment and medical abortion policy. The role of feminist activists as "shock troops"—doing underground abortion referrals and counseling, conducting speakouts, sit-ins, and demonstrations—was critical for the timing of the Supreme Court decision and earlier decriminalization statutes in several states.
Unfortunately, the impact of feminist ideas about abortion and birth control was less clear. Part of this confusion was the failure of women’s liberationists of the pre-Roe period—unlike the present reproductive rights movement—to distinguish sharply between the demand for birth control and abortion services on behalf of women’s choice and the aims of population control. As in the late nineteenth and early twentieth centuries, some feminists of the "second wave" conflated their values about abortion as a social need and right of all women with arguments about "overpopulation," echoing the dominant ideology and state policy.69 The result was, in the late 1960s, a deepening of divisions between the mainly white women’s liberation movement and the black liberation movement, whose predominantly male leadership, from its most militant to its most conservative wings, had long been suspicious of any government-sponsored family planning program as a weapon of racial "genocide." Given the racist policies of government-funded clinics and family planners—targeting minority neighborhoods for family planning services; providing birth control devices and "follow-up" in abundance, but not jobs, decent housing, basic health care, maternity care or child care; sterilizing poor black, Hispanic, and Native American women without their informed consent— these suspicions grew out of a stark reality.
But the polemic about genocide has usually overlooked the distinction between birth control and population control. It has ignored the question of who controls, and the very real need of black and other ethnic minority women to control their fertility, which necessarily requires government funding and services. Occasionally it has carried a populationist-misogynist message of its own, such as the statement of one Florida NAACP official that "our women need to produce more babies, not less. . . ; until we comprise 30 to 35 percent of the population we won’t really be able to affect the power structure in this country."70 Black women, speaking out of their identity within the black movement but with a feminist voice, responded forcefully to such statements and the male supremacy they implied. Acknowledging the racism of population control policies, Toni Cade Bambara, Shirley Chisholm, and others argued that the "male rhetoric" of genocide went against the needs and feelings of black and Puerto Rican women growing out of their own responsibilities for children and could not be heeded at the expense of those women’s lives or the well-being of their children.71 Opposition to population control and support for birth control and abortion as paired feminist values originated here, in the political thinking and experience of black women.
Another ambiguity in the white feminist movement’s ideas about abortion arose from its emphasis on the practical rather than the theoretical or broadly social aspects of abortion. During the New York State campaign, radical feminists made clear the differences between their approach, which emphasized concrete access to abortion for all women, and that of more liberally oriented groups (e. g., the National Association for Repeal of Abortion Laws, which became the National Abortion Rights Action League, or NARAL), which emphasized the legal "right to choose." Feminists consistently opposed legislative proposals that restricted legal abortion to licensed physicians, therapeutic criteria, and so forth, insisting on the importance of paramedicals and nonhierarchical forms of reproductive health care if all women were to have access to services.72 This was a practical way to critique the elitism of the medical care system and the abstract idea of abortion as a private matter between "a woman and her doctor." For the majority of women did not and do not have access to a cozy, confidential relationship with a private physician, traditionally the ticket to a safe abortion. Thus the feminist position implicitly called for substantive changes in the quality and conditions of reproductive health care. But this practical approach was not developed into an analysis and an ideology that could communicate to popular understanding the sexual and social as well as the health reasons why women of all classes and age groups, married and unmarried, ought to have access to abortion; why legal abortion is a positive benefit and not a "necessary evil."
The philosophy of removing the state from abortion decisions altogether, of repeal pure and simple (implied in the slogan "Get the State’s laws off our bodies") is at bottom one of laissez-faire. It contains an implicit presumption that the "right to choose," or the relegation of abortion to the private sphere, will in itself guarantee that good, safe abortions will be provided. Many feminists have understood that this is not a reasonable presumption; the existing medical-care system, like other capitalist markets, does not adequately meet people’s needs; how and by whom abortions (or other health services) are provided is a critical dimension of whether real needs will be met. This deeper understanding was often implicit in how radical feminists conducted the abortion struggle, but it failed to be translated either into a popular feminist discourse or into public policy. More seriously, the powerful idea that restricting abortion means compelling motherhood, that motherhood is a social relationship and not a punishment or a destiny, remained—remains still—far removed from the consciousness of most people. As a result, feminists in the campaign for legal abortion won the battle but not the war. On the level of public discourse—policy, law, media representation—the feminist voice on the abortion question was and remains barely audible. More disturbing, within popular consciousness, it would seem that medical and neo-Mal — thusian, not feminist, justifications for abortion prevail.
Yet, in a vague and diffuse way, on some deeper cultural level, articulated in a negative sense by the antifeminist right wing, the women’s liberation movement of the 1960s and 1970s brought to light the taboo sexual meanings of fertility control politics that the family planning and population control establishment had tried so methodically to conceal. More than anything else, the fight for "abortion on demand," as a demand of and by women, asserted these meanings even when some feminists were not eager to, or when their ideas about abortion remained rhetorical and confused. When a large and clamoring body of women—single, lesbian, and divorced, as well as married with kids, or grandmothers—began marching by the thousands for legal abortion, it created a political context that by definition exposed the connections between fertility control and women’s sexuality. As a reaction to this feminist movement, the conservative forces now in power and the sexual/family ideology they represent are a challenge not only to feminism but to the hegemony and contradictions in the previous thirty years of population control and family planning policy. For the former policy hoped to make birth control (and, later, abortion) available but without any radical sexual or gender-related consequences.73
In the late 1970s, the pendulum began to swing back again, and the preoccupation of policy makers, public and private, with population control receded before their growing concern to refortify the boundaries of sexual control. This was apparent in the first Hyde Amendment, passed in 1977, to cut off most federal funds for abortion services. There the impulse of legislators to curb "promiscuous sex" among poor young women seemed to take priority over their more recent urge (since the 1940s) to reduce the fertility of the poor. The past two decades of liberalized policies around fertility control, including abortion, are perceived as having unleashed a wave of "illicit" sexual activity, especially among young unmarried middle-class women but also among welfare recipients. Thus the policies must be revised; the connection between fertility control and sexual freedom must be contained. But it should be clear that this readjustment of policy has little to do with political parties, nor is it the invention of the New Right. Antiabortion policies have been a constant under every president since Eisenhower, and the constitutionality of abortion was declared in spite of verbal presidential opposition. These shifts reflect, not partisan leanings, but the tensions embedded in the patriarchal state between population control and sexual control; and the persistent view of abortion as uniquely subversive.
There is a lesson to be learned from Roe v. Wade, a lesson that could have a bearing on its sequel in the 1980s. If, after a century of medical and eugenicist domination of reproductive politics, abortion became legal in the first place, it was because at a particular historical moment social need, feminist activism, and populationist ideology came together. This was sufficient to change state policy, but in order for that change to have been radical—a liberating force for masses of women, and lasting— social need and feminist activism would have had to merge with a popular feminist ideology, one that turned the accepted meanings of abortion upside down. And this did not happen.