The Moral Veto: Framing Contraception, Abortion, and Cultural Pluralism in the United States (review)

This is not at core a medical history, but rather an argument within the sociology of social movements, using campaigns for and against contraception and abortion as a case study to make a point about when and how social movements win. It may be of interest to historians of medicine because of the light it sheds on the role of physicians in these controversies—and because so many of the medical issues it raises become surrounded by controversy.

Gene Burns begins by distinguishing between two ways that policy-change advocacy is framed: with a moral worldview and with limited goals. Advocates for the decriminalization of contraception and abortion, both in the early twentieth century and among second-wave feminists, first built their cases on radical ethical and social values: universal rights of privacy, of control over one's own body, of women's citizenship as well as social equality—these being examples of moral worldviews. These campaigns did not get very far because the totality and radicalism of their claims kept them as minority positions. Liberalization of reproduction-control laws took place, Burns argues, only when advocates limited themselves to lowest-common-denominator values, such as maternal and infant health. Similarly, antiabortion advocates do not succeed with apocalyptic claims—for instance, that abortion is like the Holocaust.

The greater success of lowest-common-denominator arguments is often empirically observable (albeit not a particularly original observation); but as a general principle regarding social movement success, and that is what Burns is offering, it cannot stand historical scrutiny. Of course reforms are usually more limited than their most passionate advocates hoped, but that is because compromise is the typical stuff of politics. But often these modest reforms would never even win a place on the public political agenda without the more total-worldview arguments of radicals, and the consciousness-raising that their discourse produces. Moreover, sometimes movements shift in the other direction: after beginning with moderate claims, they move to more radical ones. This is the story of the American, French, Russian, and many other revolutions; of the temperance campaign winning prohibition; of the anti–Vietnam War movement coming to support the Vietnamese National Liberation Front.

In making his case, Burns frequently defends elites, rejecting charges that they typically have a "nefarious" intent to make policy behind closed doors, excluding the public and avoiding transparency. This would be a dubious defense even if it mattered what the intent was, and it does not: the horse-trading, log-rolling, and outright corruption that characterize politics depend on those closed doors. Burns implies that elites control policy discourse because they have learned to limit frames and reject absolutist moral principles. But his causality is backward: those with power learn to make coalitions. Burns's analysis ignores how political power works: it is not discursive frames but resources and alliances that determine elite membership and control. This mistake is notable particularly in Burns's view of the medical profession. In an ahistorical analysis, he assumes that courts defer to medical expertise because it uses non-moral-worldview categories. In fact, physicians have frequently made intensely moralistic claims; the deference derives rather from the social and economic power of the medical profession.

Not least among these problems is the question, what constitutes success? Burns analyzes the antiabortion movement as largely a failure because it has not succeeded in outlawing abortion entirely—but that conclusion can be defended only by accepting the most apocalyptic goals of the movement. Its considerable success can be seen in the loss of access to abortion services, the defunding of global reproductive health programs, and in the agonizing and guilt that commonly accompany abortion decisions—attitudes more widespread today than they were when abortion was a crime.