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

Johanna Schoen's Choice and Coercion is a series of interlinked studies of birth control, sterilization, and abortion, based largely on evidence from North Carolina, with a final chapter that addresses the comparative history and politics of reproductive control in India and Puerto Rico. Particularly in relation to the history of reproductive control in North Carolina between the 1920s and the 1970s, Schoen demonstrates that the state alternately offered and denied poor women access to birth control, sterilization, and abortion and that women negotiated with their physicians as well as health and welfare officials in their attempts to control their reproduction.

Schoen works from a dazzling array of material, ranging from women's narratives, court records, and philanthropists' accounts to governmental policy, social workers' reports, and physicians' interviews and private papers. Schoen sifts through this evidence with remarkable care and tact, providing a picture of the changing nature of women's access to reproductive technologies over several decades. The strength of the work lies in how Schoen refuses to shy away from complex and competing accounts of a fraught set of topics.

If at times I worried that the book worked better as a series of essays than as a monograph, at other times—particularly while reading her truly outstanding chapter on abortion—this structural issue seemed well worth overlooking. In "Negotiating Abortion before Roe v Wade," Schoen reads nearly a century's worth of North Carolinian women's experiences with abortion against the accounts of physicians and irregular practitioners. She deftly charts changes in women's experiences alongside the changing and often incoherent legal, juridical, and medical frameworks that they encountered.

Rather than being content with confining her investigation to North Carolina, Schoen seeks to place the local material into both a national and a global framework. Schoen claims that "North Carolina's reproductive policies were part of an international experiment with family planning" (p. 12). This is a provocative claim and one with which I am sympathetic. Schoen's work implicitly poses the question: Are the networks of official and everyday power that animate the relationship between reproductive technologies and the women who use them broadly similar across the globe? This is a vital question for any student of reproductive health in the modern world and I daresay for any feminist worth her salt today.

The enduring urgency of the cross-hatched issues of technology, access, and micropolitics came back to me when, as I was reading Schoen's book, I saw reports from the United States of a current movement among so-called rogue pharmacists who refused to fill prescriptions for emergency contraceptives and birth control pills (Rob Stein, "Pharmacists' Rights at Front of New Debate,"Washington Post, Monday, 28 March 2005, p. A01). I read of these events as an American who grew up in the happy shadow of Roe v. Wade but long since fled to the United Kingdom, a country in which contraception is the only nonmeans-tested, free prescription universally available through the National Health Service. Read alongside Schoen's multilayered account of the complex histories of reproductive technologies in North Carolina, American rogue pharmacists' direct action highlights the pungency of reproductive health politics and together suggest that perhaps no place but in the United States are we so regularly and so audaciously reminded of the precarious nature of women's access to safe and legal methods of reproductive control.

So, although I am an historian of modern India and not of the American south, I found the material on North Carolina compelling and highly accessible. Perhaps predictably my worries about Schoen's book center more on her claims to suture the history of reproductive politics in North Carolina to the history of reproductive politics in the third world.

Thus I ask: Is the American experience part of a set of global trends or is it particular to...