When President Dwight D. Eisenhower was asked in 1959 about the federal government’s relation to birth control, he replied: "I cannot imagine anything more emphatically a subject that is not a proper political or governmental activity or function or responsibility. . . . That’s not our business." Four years later, however, President John F. Kennedy hesitantly voiced his approval in principle of federal support for contraceptive research. By 1965, Eisenhower had reversed his position on public support for family planning, and had become, with former president Harry S. Truman, a co-chairman of Planned Parenthood-World Population. … By 1967, the Agency for International Development was spending almost nine million dollars annually on birth control abroad, and the Department of Health, Education and Welfare, with the Office of Economic Opportunity, spent over twenty million dollars for contraceptive programs in this country.34
State intervention in fertility control occurs for three different purposes, called forth by a combination of social conditions and conscious political activity. These purposes are population control, the regulation of sexual behavior and sexual norms, and the state’s need to maintain social order and the legitimacy of its rules and rule-making system. When legitimacy breaks down and the state is no longer able to enforce its policies, as happened with the draft and U. S. military intervention in Vietnam, then "concessions" have to be made that will restore legitimacy without seeming to compromise the dominant ideology informing a given policy (and thus the authority of the state).35
In the early 1970s, abortion became legal in the United States, and the "right to abortion" was given constitutional protection because essentially it could not remain illegal, because the old laws could no longer be enforced, even symbolically. They had lost their credibility and their power when so many women (1) were clearly willing to defy the law in order to get abortions and were able to find cooperative providers, (2) were defining their lives increasingly in terms of work and education more than marriage and childbearing, and (3) were claiming these acts in the name of "women’s liberation." And they contradicted the capitalist economy’s tendency to draw on expanding pools of younger (married and unmarried) women workers. But in making concessions to the movement for legal abortion, the state—and the population policy establishment that had become the architect of state policy on fertility—carefully avoided concessions to feminist ideology about reproductive freedom. To accommodate popular pressures without legitimating feminism—or acknowledging the true causes of the need for abortion—state and population planners subsumed abortion politics under the rubric of population control.
The relegalization of abortion by the Supreme Court in 1973 (prior to that in some states) in part paralleled the gradual emergence of the state as the central coordinating agency and terrain of fertility control politics in the United States and internationally. But this process had little connection to women’s right to legal abortion, either in theory or in practice. It was spearheaded by a coalition of private and family planning organizations, foundations, and corporate interests organized around the population issue. Groups like the International Planned Parenthood Foundation (IPPF) and the Population Council, formed in the late 1940s and early 1950s, together shaped what was to become population and fertility policy in this country and its dependents in the Third World for the next thirty years, persistently seeking government funding and support and with astonishing success achieving it. In this way, the federal government—in spite of politicians’ traditional avoidance of confrontations with the church and their extreme discomfort with "sexual" issues— became recruited, rather late in the day, into the "population" field.
From the 1930s through the 1950s, the federal government had steered away from visible involvement in family planning. By 1965 it was clear that birth control had achieved a new public presence and legitimacy; as early as 1960 a government agency, the Food and Drug Administration, had approved oral contraceptives for commercial distribution. In 1965, following five years of pill use by American women, the Supreme Court denied the constitutionality of state laws prohibiting the sale of contraceptives to married couples; the OEO was given its "first sizable project grants" for family planning; Truman and Eisenhower, paternal symbols of state authority, joined the board of IPPF; and the Gruening Committee began its influential Population Crisis Hearings in the Senate, which mainly focused on the need for population control in the Third World.36 All these developments, and the mushrooming of federal government activity and spending that succeeded them, were responses to two sets of pressures: (1) population control ideology, as put forward by the population policy establishment, and (2) the growth of birth control practice.
These two developments were and are relatively independent. In reality, state officials and the population control agencies that in effect shaped population policy from the 1950s to 1970s would have avoided legal abortion if they could have. Abortion has never been an efficient method of reducing fertility from the standpoint of population controllers. While relatively inexpensive, it is impermanent, works after the fact rather than preventively, and in that sense is a direct response to a woman’s own decision about a pregnancy at hand rather than a technical answer to her "fertility status"—all in contrast to the preferred methods of population controllers: surgical sterilization and long-acting hormonal injections (see Chapter 5). Besides, abortion arouses a far more intense, organized political opposition, particularly from the Catholic church, than these other methods do. When it became clear that legal abortion could not be avoided, the population establishment rationalized the change in law by invoking the specter of the "population explosion."
Beginning in the mid-1950s, statistical demographers, geographers, family planners, and econometricians began to signal a "population explosion," particularly in the Third World (the image of a bomb exploding was meant to resonate with the atom bomb). "Excess population," they warned, would devour food supplies, accelerate poverty and unemployment, "destabilize" the political climate, and therefore endanger both foreign investments and world peace.37 Thus, the idea of a population explosion seemed to give neo-Malthusian thinking and practices "a new scientific basis," a new source of legitimation, which it had lost after the Nazi horrors.38 Despite voluminous statistics and numerical projections marshaled in support of this idea, the aura of "scientific" authority barely disguised old-fashioned racist and eugenic images. Brochures published by population groups like the Draper Fund and the Population Council showed hordes of black and brown faces spilling over a tiny earth, while ads in the New York Times, signed by prominent industrialists, appealed to middle-class urban dwellers’ fears of slums, riots, violent crime, and the poor. Proposals were entertained to put sterilants in the water or food of Third World countries and to tie foreign aid to such countries to their participation in family planning programs. (The latter, of course, became U. S. policy, through the Agency for International Development.39) Now that the idea of "overpopulation" as a "crisis" may be waning, it is hard to recapture the intensity with which that idea seized the imagination of businessmen, academics, middle-class professionals, and policy makers in the pre-Roe v. Wade period.
The centers of power most responsible for promoting the ideology of overpopulation were private foundations and organizations whose founders and directors consisted mainly of top corporate and financial leaders and biomedical scientists representing elite population research centers. Central among them was the Population Council, founded by John D. Rockefeller III in 1952 to "rally scientific and political support" for population control; to finance "the scientific information, the technical plans, the training programs and the professional personnel" necessary for its execution; and, above all, to help formulate an overall public policy in the population field.40 Also important was the Hugh Moore Fund, set up by the owner of the Dixie Cup Corporation in 1954 and instrumental in developing the propaganda campaigns that succeeded in winning over many businessmen to the population control bandwagon.41 Both prior to and during the U. S. government’s active involvement, such corporate groups functioned as central agencies of policy formation, organizational and professional coordination, and ideological dissemination of a dominant population strategy. The larger political and social context of all this activity was the development of the United States as a major imperialist power with enormous economic and military interests throughout the Third World; and the development in Third World countries of national liberation movements that threatened U. S. power and investments. The equation of "political instability" with population growth rates, while incorrect even from the imperialists’ viewpoint, nevertheless provided a simple, technically manageable way to rationalize political conflict as well as lagging development in the Third World.
There was also a domestic side of this context in the migration of blacks to northern cities and the growing militance of the civil rights movement. Thomas Littlewood analyzes the extent to which shifting alignments around the increase in government-sponsored family planning programs in the 1960s reflected racial conflicts and a deeply embedded racism within the dominant power structures. He points out that racial and ethnic population patterns affect "voting blocs," especially in populous northern and midwestern cities and states, and can often tip the balance in elections. Thus the migration of many blacks into New York, New Jersey, Ohio, Detroit, and Chicago threatened political machines rooted in white "Catholic European ethnic groups/’ as well as the power of the Catholic church.42 But the racism of population control politics runs deeper than calculations of voting blocs. When demographers publish "scientific" studies warning about the "racial aspects of zero population growth" and citing projections about what proportions of the population will be black or Hispanic by the year 2000 if differential birthrates continue/3 the clear message to white elites is no different from that of the eugenicists earlier in the century.
A population politics embedded in racism and corporate capitalism’s need for "stability" may, however, collide with a sexual politics that seeks to curtail the sexual options of young people outside of heterosexual marriage and defer to the moral codes of organized religion. That is why the United States has never developed a coherent population or sexual policy. Until the mid-1960s, "opposition from Catholic organizations. . . remained an obstacle to the adoption of government-financed population planning programs domestically, or as a component of foreign aid."44 Even afterward—certainly with enormous vigor by the mid-1970s—the church was able to wield its political power to intimidate politicians from tampering with the "divisive" issue of birth control. Every president beginning with Eisenhower has at least publicly deferred to the views of the church on birth control and abortion. This influence, if not successful in stopping family planning programs, has had a decisive impact on their scope so that, for example, early family planning grants were restricted to married women living with their husbands.45 No president has openly supported legal abortion. In a particularly revealing chronicle of a situation in the early 1960s in Illinois, where the church held formidable political power, Littlewood shows the tactics and equivocations of the church in its campaign to block the establishment of state-sponsored birth control services available to all women (i. e., in public hospitals without restrictions on age or marital status). Registering strong opposition to a legislative proposal to provide birth control services in Cook County Hospital, the vicar general of the Chicago diocese sent a telegram to the members of the County Board of Commissioners "to make the Catholic stand perfectly clear." The message not only voiced the "vehement" objections of the church to the proposal but did so in terms that strongly threatened retaliation at the polls46—foreshadowing the antiabortion tactics launched by the National Conference of Catholic Bishops in 1975.
The reasons for the church’s militant position on government-sponsored family planning are not purely doctrinal; they are also political. On one level, there is a sense in which the government’s involvement in family — and sex-related issues represents a jurisdictional challenge to the church, a threat to its institutional role as guardian of "morality." It is the public legitimation of fertility control practices and not the practices themselves that the church actively campaigns against. On another level, the church’s numbers are surely a source of its power in terms of congregants, schoolchildren, and activists in church-related causes, as well as potential voting blocs. This reality helps explain the otherwise puzzling outcome of the Illinois family planning dispute. For finally, after months of adamant opposition from the church and Catholic politicians, legislation was passed in Cook County to provide birth control services to welfare mothers over the age of fifteen, regardless of their marital status—and the church quietly, in the end, complied! Littlewood suggests that the reason had to do with racial and ethnic divisions—specifically, the fear in Catholic ethnic parishes and neighborhoods of the growth of black populations in their districts. He implies that in some locales deals were made between Planned Parenthood affiliates and the church to concentrate family planning centers in black neighborhoods and keep them out of Hispanic and white ethnic neighborhoods where the church had its base.47 Thus, while decrying the "evil" and "immorality" of government-sponsored family planning services, the church’s position in practice may not have been so far from that of the (now closely allied) business leaders and government bureaucrats whose main concern was to lower welfare rolls and "dependency rates."
Under the Nixon administration, government population policy reached a new level of organization as well as manifesting all the contradictions that characterize it today. In 1970 Congress passed the Family Planning Services and Population Research Act, which set up an Office of Population Affairs and a National Center for Family Planning Services in the Department of Health, Education, and Welfare. In essence, it committed the government to "providing services on a voluntary basis to every wanting woman," and to allocating resources to make this possible. The Senate passed this legislation unanimously and with "little debate," in a moment when population control ideology was at its peak; yet, to "mollify the U. S. Catholic Conference," it included a provision "that none of the funds could be used for any program that included abortion as a method of family planning."48 Similarly, the same Nixon who asked for an increase in federal spending for family planning remained publicly opposed to abortion. Having appointed a special Presidential Commission on Population Growth and the American Future—chaired by none other than John D. Rockefeller III and studded with population establishment and high corporate luminaries—he nevertheless rejected the portions of its final report that endorsed legal abortion and providing birth control services to minors:
… I want to reaffirm and reemphasize that I do not support unrestricted abortion policies. … I consider abortion an unacceptable form of population control In my judgment, unrestricted abortion policies would demean human life. I also want to make it clear that I do not support the unrestricted distribution of family planning services and devices to minors. Such measures would do nothing to preserve and strengthen close family relationships.49
What Nixon was "reaffirming" here was not only a conservative sexual politics but an idea of government-supported family planning as legitimate only for population control. Yet, while Nixon took this position publicly and in relation to the church, he never did anything in practice to stop HEW’s policy of supporting the delivery of birth control services to minors, and it was during his administration that Roe v. Wade was decided. It was also in this period that involuntary, or nonconsenting, sterilization of poor women through federally sponsored family planning clinics, particularly in the South, "took off"—apparently with executive knowledge, if not blessing.50 Clearly, Nixon (and every other president) wished to appear to oppose abortion in order to preserve the political support of the church, but also to flow with the heavily corporate-backed population control movement, which by now favored not only government-sponsored family planning services but also legalized abortions. The Nixon administration’s aim, though perhaps served by little more than rhetoric, was to mediate the conflict between population control (supported by a powerful array of private corporate, foundation and institutional interests as well as liberal politicians) and sexual control (supported by the Catholic church and many conservative and right-wing political groups whose allegiance Nixon still tried to gain). Foreshadowing the Carter and Reagan administrations, Nixon carefully targeted the issues of abortion and teenage access to birth control to define the cutting edge of the sexually illegitimate, although in a general context that approved of state-sponsored population control.
In fact, in the late 1960s and early 1970s—the period of the Vietnam war and the transition of the black civil rights movement from nonviolence to militance—the pendulum of the sexual control-population control dichotomy swung far in the direction of the latter. That fact plus the persuasiveness of "overpopulation" ideology helped rationalize a growing lobbying campaign among population control groups to liberalize the abortion laws. The Commission on Population Growth’s positive recommendation on abortion in 1972 followed years of active soliciting for "abortion law reform" in which John D. Rockefeller and other establishment leaders had played an important role. Some of the tenor of their thinking is conveyed in a talk that Rockefeller gave at an international conference on abortion in Virginia in 1968, where he carefully placed the justifications for "reform" within a "moral" framework.51 Three major themes were sounded by Rockefeller, all of which he defined as "moral problems" and all of which became important bases of the public policy, including the Supreme Court’s decision, that would congeal in 1973. These themes were the ideological core around which a proabortion consensus among population groups, family planners, medical organizations, and government officials was being worked out.
First, and most significantly, Rockefeller made the utilitarian argument that abortion is inevitable and unstoppable, that its prohibition leads to large-scale "disrespect for the law," which in turn creates a "gradual erosion of the moral fabric that holds society together." Thus abortion should be legalized for the sake of social order and stability. Second, he presented a public health rationale and a set of medical conditions for liberalizing abortion: that it should be performed in hospitals by "duly licensed physicians," with a broadening of the "mental health" criteria (as presumably determined by doctors). Finally came an argument on behalf of the "unwanted child," who should have the right to "a life of dignity and self-fulfillment" or, it is implied, no life at all ("children’s rights"). Nowhere was there any mention of the needs of women, much less the right of women to control pregnancy.
We should not exaggerate the role of the population control establishment in achieving legal abortion but should recall that eugenic and Malthusian ideas had never been used to defend legal abortion. Quite the contrary. Fears of "tainting" the now sanitized family planning field kept abortion a taboo and isolated subject. Only in the late 1960s did population control advocates and family planners begin to draw these connections, and then with pronounced caution and reluctance. (Rockefeller in 1968 spoke of the need for abortion as "regrettable" and "always a tragedy.") In fact, the neo-Malthusian ideology of the population explosion and the medical ideology of "therapeutic" or "mental health" reasons for abortion combined to provide a "respectable" rationale for a legal reform that many liberal professionals, academics, clergy, businessmen, and policy makers had already come to see as inevitable.
The reasons for this sense of inevitability are revealing and take us back to the arguments of Rockefeller that the criminal statutes could not be enforced and that this situation threatened "respect for law." The laws that made abortion a felony, except in cases of life endangerment, could not be enforced because millions of women, and some doctors, were determined to defy them—out of a sense (for the women) of pressing personal need. Abortion had to be legalized because the pressure of popular practice on doctors, health facilities, and finally the state had become irresistible. Indeed, the frequent emphasis of abortion reformers in pie-Roe days on rising reported deaths and serious complications reflected a reality caused by the increase in illegal abortions. It was an increase rooted in conditions that were massively changing women’s position, family life, and sexuality in American society: not only the rise in women’s labor force participation and college attendance, their later age at marriage and increased divorce rates, but the increase in contraceptive use (see Chapter 5). The population controllers’ and physicians’ participation in the abortion repeal campaign was an accommodative response to a trend they could not stop; their commitment was one not of principle but of pragmatism.
Along with the population control organizations, both the medical and the family planning professions were moving toward a proreform position by the late 1960s. For both groups—strong working allies for decades—two planks of the incipient policy mapped out by Rockefeller were compelling: (1) the guarantee of medical means and medical control, which family planners had long welcomed; and (2) the association with eugenic ends, to which doctors have often been sympathetic. The AM A passed a cautious, medically oriented resolution in 1967 in favor of a somewhat liberalized abortion law. The American Public Health Association, always more socially conscious than the AMA, followed this pronouncement with a more far-reaching resolution in 1968, which called for the repeal of restrictive abortion laws. Finally, the family planning establishment, under the leadership of Dr. Alan Guttmacher (himself an ob-gyn), joined the movement for safe, legal abortions. Planned Parenthood members in 1969 approved the proposal that existing criminal statutes be abolished (this had already occurred, at least on a partial basis, in some ten states), and its affiliates began to work with the movement to establish referral services and freestanding clinics.52 These policy changes reflected a broad and growing sentiment among middle-class professionals, particularly liberals in the public health, social work, and family planning fields, as well as civil liberties lawyers and socially oriented clergy, in favor of abortion reform. It was a sentiment stimulated in part by humane considerations, by direct contact with the horrendous social consequences of illegality; and it became organized into effective lobbies.
In 1970, acknowledging the growing trend in state legislatures and courts "to make abortion more freely available," the AMA’s House of Delegates resolved that this liberalizing trend should be contained within a medically defined and medically controlled framework. "Sound clinical judgment" and "the best interests of the patient," rather than "mere acquiescence to the patient’s demand," should govern the procedure, which "should be performed by a licensed physician in an accredited hospital only after consultation with two other physicians. . . ."53 While the conservatism and professional self-protection inherent in this statement are clear, it also marks a distinct shift in AMA policy on abortion. After a century of strictly moral opposition to abortion on practically any grounds, the AMA was now conceding that abortion for "medically necessary" reasons was legitimate.
What accounted for this sudden shift? It is surely the case that growing numbers of physicians and public health nurses were witnessing a virtual epidemic of perforated uteruses, infections, and deaths caused by illegal abortions in the 1960s; their awareness grew that this was an unnecessary tragedy. But public health reasons cannot fully explain the shift. Sensitive clinicians had been aware of the health risks to women, especially poor women, from illegal abortions since the late nineteenth century. Rather, both the change in medical policy and the changes in the law—which were mutually reinforcing—reflected the larger social and political context in which they occurred. This context included the population control movement pushing on one side and the activists in the feminist health movement and liberal reform organizations pushing on the other. But more than anything else, it included masses of women who, regardless of legal constraints and personal risk, were determined to get abortions.