- Choice and Coercion: Birth Control, Sterilization, and Abortion in Public Health and Welfare
This important book on reproduction and U.S. social policy between 1920 and 1970 shatters conventional assumptions about reproduction, race, and welfare. Focusing on North Carolina but ranging widely across the United States, Puerto Rico, and even India, Johanna Schoen argues that state policies on birth control, sterilization, and abortion worked both to expand and to limit women's control over reproduction. Poor women of color who wanted birth control often welcomed eugenic sterilization and contraceptive testing, which scholars have condemned as controlling; at the same time, efforts to legalize abortion, usually seen as liberating, were inspired partly by eugenics and could be coercive. Schoen's exceptional research in local sources and her deep understanding of global population policies make this provocative book a must-read for anyone interested in reproduction, women's health, and eugenics.
On one level, Choice and Coercion is a case study of reproductive health care in North Carolina, which Schoen argues was framed by and, to some extent, mirrored international developments. In the 1930s, the philanthropist birth-controller and eugenicist Clarence Gamble conducted contraceptive field trials in North Carolina, distributing spermicidal foam powder to poor women through public health clinics; he also financed similar trials abroad. Yet reproductive policies also served specific local needs, and Schoen notes the many ways in which North Carolina was unique. It was the first state to establish a state-supported birth control program (funded largely by Gamble), and one of the first southern states to offer equal public health services to blacks and whites. North Carolina had one of the most active and longest lasting eugenic sterilization programs in the country, and in the 1960s it was one of the first states to liberalize abortion law.
Reproductive policies in North Carolina were also unusually well documented, and Schoen has made brilliant use of an astonishing array of sources, from the well-known Gamble papers, to the illegal abortion cases that came before the North Carolina Supreme Court, to the North Carolina Eugenics Board's in-depth summaries of 7,500 sterilization petitions. No other scholar has had access to such detailed material on sterilization, and Schoen generously shared the results of her research with a reporter from the Winston-Salem Journal; the result was an award-winning series about the state's eugenics program, an apology from the governor, and a compensation program for survivors. The epilogue to Choice and Coercion is a moving account of these developments and a perceptive critique of the politics of sterilization apologies.
As Schoen describes twentieth-century reproductive policy, it was chaotic, contradictory, and shaped by conflicts of sex, race, and class. The progressive impulse to extend health services to the needy conflicted with a conservative hostility toward services for the poor; the desire to expand women's reproductive choices intersected with eugenics-based efforts at population control. Religious beliefs and [End Page 390] institutions play little role in Schoen's analysis. Rather, she argues that reproductive policies in North Carolina and elsewhere developed through the interactions of four largely secular groups: scientists, health-care providers, public health and welfare program administrators, and the women targeted by the programs. Ironically, the expanding welfare state provided more-equitable access to health services while increasing the possibility of coercion. In the early twentieth century, most women lacked reproductive choices because they lacked basic health services. In the postwar period, social programs and new technologies (e.g., IUDs inserted by doctors instead of the spermicidal powder that women applied) brought new threats to women's reproductive control. Yet women remained active agents negotiating for control over their reproductive decisions.
Although more local studies are needed to test Schoen's findings in settings that are (for example) more urban and more Catholic, and where a greater proportion of sterilizations were performed on men and...