Choice and Coercion: Birth Control, Sterilization, and Abortion in Public Health and Welfare (review)

Schoen's well-written book signals from the title that the politics of fertility variously underwrites both autonomy and constraint. In fact, Schoen's work argues that women who live under a regime of reproductive constraint often search for ways to wrest reproductive autonomy out of the teeth of coercion. This book focuses, with appropriate complexity, on the related histories of birth control, sterilization, and abortion, showing how physicians and politicians crafted and enforced various interventions over time, while women consistently recognized and often acted upon the need to manage their reproductive capacity, no matter what the law or the authorities said.

In an era when most Americans reduce this fraught terrain to the peculiar binary "choice"/"life," Schoen's complicated perspective is particularly illuminating. She shows how, for example, during the Depression, workers in one segment of the federal government—the Farm Security Administration—treated the use of birth control as a mark of "forward-looking citizenship," even while the head of the Women's Bureau forbade states to use federal money for programs that dispensed contraceptive advice. Where birth control was available during this period generally only white women had access, making modern fertility control a racial privilege. Less than thirty years later, government programs were to target poor African American women in the context of anti-welfare, anti-population growth, and civil-rights movements. Meanwhile, millions of women of every race—rich, poor, and middle class—took advantage of any opportunities to limit their pregnancies.

Similarly, Schoen shows that the practice of sterilization in the United States has been more complex than sometimes portrayed. Women with few economic resources and less social power could be caught in official or unofficial anti-fertility stratagems. Sterilization was variously touted and practiced as a way to ward off poverty, to punish or stamp out criminality, to abort mental deficiency (sterilization functioned as abortion before the fact), or to reduce welfare expenditures. Schoen also argues that sterilization could be—and was—an opportunity for thousands of women who had no other way to limit conception.

Once again, in relation to abortion, Schoen stresses the ways that a variety of agendas—be they physicians', politicians', women's, or clerics'—yielded an array of different "kinds" of abortion—elective, therapeutic, and eugenic. Schoen effectively reveals how ideas about aborting women changed over time and also how the target of abortion prosecutions shifted, from the man who caused the pregnancy (and putatively, the abortion) to the abortionist. This work also provides interesting material on North Carolina legislative maneuvers regarding legalization during the late 1960s and early 1970s. Schoen's lack of attention to the prevalence of self-abortion allows her to suggest that inept practitioners were the chief source of danger to women in the criminal era, not the law itself, which demanded that women submit to enforced childbearing or resort to dangerous methods. In Schoen's history, legal abortion becomes more a form of consumer protection than a women's rights issue. Furthermore, although Schoen's title signals complexity, it notably glosses specificity. The heart of the book focuses exclusively on North Carolina roughly from the 1930s to 1970.

In the course of researching and writing this book, Schoen was able to stimulate an enterprising North Carolina newspaper reporter to write, and convince his editor to publish, a series of articles about the state's Eugenics Board sanctioning the sterilization of hundreds of poor women in the mid–twentieth century (Schoen calls the Board's approach to every case an "almost automatic authorization of sterilization" [129]). This is the sort of impact that many academics dream of initiating and rarely achieve.