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Bulletin of the History of Medicine 75.1 (2001) 180-181



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Intended Consequences: Birth Control, Abortion, and the Federal Government in Modern America


Donald T. Critchlow. Intended Consequences: Birth Control, Abortion, and the Federal Government in Modern America. New York: Oxford University Press, 1999. x + 307 pp. $30.00.

Donald T. Critchlow's study of federal family-planning policy provides us with a rich, densely documented, and shrewd political analysis of the groups and individuals attempting to influence family planning domestically and internationally from the 1950s through the 1990s. Organized roughly chronologically, the book begins with a succinct overview of the emergence of a "population movement" after World War II, when the very different concerns of three main groups (the Planned Parenthood Federation of America, eugenicists, and proponents of population control) called for more coherent and decisive governmental intervention. Chapters 2 and 3 examine family-planning policies in the Kennedy, Johnson, and Nixon years; chapter 4 analyzes the emergent backlash--chiefly over abortion--that decisively altered the cultural landscape; chapters 5 and 6 chronicle the ever-more-complex politicization of the issues from the Nixon to the Clinton years.

Readers who want a clear and judicious history of the most important actors, legislation, and court decisions in these decades will find the book extremely useful. In addition to the text, the endnotes provide in places almost a second volume in their minute analysis of sources and issues. Even more important is the book's coverage of hidden aspects of policy history that are notoriously hard to recapture historically. Critchlow's impressive archival mining of personal papers and organizational records reveals the ways in which policy was created "behind the scenes" in private meetings, personal correspondence, and quiet lobbying within the "comfortable culture" created among elite colleagues, high-level government officials, foundation officials, and policy activists (p. 69). He scrutinizes [End Page 180] records from congressional hearings and presidential archives, paying particularly close attention to John D. Rockefeller III and individuals working within Rockefeller's Population Council; to the Ford Foundation; and to the Planned Parenthood Federation of America.

No overall agency coordinated, planned, or supervised population-control/family-planning programs in the United States. Because there was no national health infrastructure through which family-planning programs could be funneled, a complex (and at times chaotic) array of private foundations, private health-care providers, and government agencies at the local, state, and federal levels provided funding, information, and services. Critchlow views this as a unique system, a blend of the governmental and the private, and his book is especially strong in its delineation of the closely intertwined and often uneasy relationships between the modern U.S. welfare state and the nonprofit private sector (pp. 94-96).

Whether presenting case studies of the implementation of family-planning programs in communities as different as rural Louisiana, New York City, and Baltimore (pp. 99-106), or describing the impact on Rockefeller's thinking of his daughters' feminism and pro-abortion stance, one major strength of this book is its attention to subtle details that affected family-planning policy. It reminds us constantly of the extent to which many aspects of family planning have changed in a generation. Before legal abortion and its backlash altered the social and cultural context so radically, family planning found broad bipartisan support in Congress. Even Catholics, the most numerous and politically the most feared opponents of family-planning programs, differed greatly in public and private about what domestic family-planning policy should be. Critchlow's documentation of the "deep ambivalence" (p. 117) among the Catholic bishopric, clergy, and laity is one of the most important chapters in his study. The book never ignores the widely differing motives and strategies among the "policy innovators" and "population control activists." Some feared excessive population growth, but others wanted family planning to end poverty, or to reduce welfare costs, or to promote women's rights.

Clarifying the proponents and their aims, keeping the broader historical canvas in focus, Critchlow also judiciously assesses the opposition--from...

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