Abortion

Author(s): Barbara Hayler

Source: Signs, Vol. 5, No. 2 (Winter, 1979), pp. 307-323
Published by: The University of Chicago Press
Stable URL: http://www.jstor.org/stable/3173563
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REVIEW ESSAY

Abortion

Barbara Hayler

Since the 1973 Supreme Court decisions declaring it a constitutional

right, abortion has become the most common surgical procedure in the
country. More than 1 million abortions were performed in 1977, and it

has been estimated that one American woman in four will have an abor-

tion sometime during her life.1 However, strong disagreements remain

over the extent of the right to abortion and its consequences. This essay,
largely about literature that supports the right to abortion, reviews the
major legal cases affecting abortion rights since 1973 and discusses research on (I) the history of abortion and birth control in America, (II)

the abortion reform movement of the 1960s and the antiabortion

movement of the 1970s, (III) the decision to abort and its physical and

mental health consequences, (IV) issues of race and class, and (V)
feminist theory on abortion. I have chosen not to review the medical

literature; Hughes's 1977 bibliography, however, includes an extensive

medical listing.2

1. The one-in-four estimate is reported in Lucinda Cisler, "Unfinished Business:

Birth Control and Women's Liberation," in Sisterhood Is Powerful: An Anthology of Writings
from the Women's Liberation Movement, ed. Robin Morgan (New York: Vintage Books, 1970).
National abortion statistics are collected annually by the Alan Guttmacher Institute (from
all potential abortion providers) and summarized in Family Planning Perspectives (published

bimonthly); the Department of Health, Education, and Welfare's Center for Disease Control (CDC) compiles statistics reported by state health departments in its annual Abortion
Surveillance Report. Information on abortion is also available from the National Abortion
Rights Action League (NARAL), 825 Fifteenth Street, N.W., Washington, D.C. 20005.
2. Marija Matich Hughes, The Sexual Barrier: Legal, Medical, Economic and Social Aspects
[Signs:Journal of Women in Culture and Society 1979, vol. 5, no. 2]

? 1979 by The University of Chicago. 0097-9740/80/0502-0007$01.27

307

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308 Hayler

Review: Abortion

The current status of abortion has been defined in a series of de-

cisions handed down by the Supreme Court during the 1970s.3 In the
landmark cases of Roe v. Wade and Doe v. Bolton,4 decided on January 22,

1973, the Supreme Court concluded that the "right of privacy . . .

founded in the Fourteenth Amendment's concept of personal liberty ...

is broad enough to encompass a woman's decision whether or not to

terminate her pregnancy." The constitutional principles enunciated in

these cases appeared to give broad protection to a woman's right to

choose and obtain an abortion, but the Court refused to recognize a
woman's absolute right to control her body. Roe and Doe established her
right to choose abortion, but that right could be limited where the state
had a "compelling interest." The Court recognized legitimate state interests in preserving and protecting the health of the pregnant woman and
in protecting the potentiality of human life. During the first trimester
neither interest is compelling, and the decision is left to the woman and
her physician. After the third month the state's interest in the pregnant

woman's health becomes compelling, and the state may "regulate the
abortion procedure in ways that are reasonably related to maternal

health." The state's interest in the potentiality of life becomes compelling

only after the fetus has reached viability; then it may regulate abortion
or forbid it except "where it is necessary, in appropriate medical judgment, for the preservation of the life or health of the mother."
While some states, like California, quickly took action to bring their
laws into agreement with these principles, many more made minimal
changes in existing statutes, enacted laws known to be unconstitutional,
and imposed new restrictions to deter women from having abortions. A
number imposed provisions which required women to obtain the consent of their husbands, and minor women the permission of their parents. The Supreme Court finally dealt with the consent issue in Planned
of Sex Discrimination (Washington, D.C.: Hughes Press, 1977); a medically oriented anthology, now somewhat dated, is Howard J. Osofsky and Joy D. Osofsky, eds., The Abortion
Experience: Psychological and Medical Impact (Hagerstown, Md.: Harper & Row, 1973); Family
Planning Perspectives provides current medical and statistical information.
3. Kristin Booth Glen's "Abortion in the Courts: A Laywoman's Historical Guide to
the New Disaster Area" (Feminist Studies 4 [February 1978]: 1-26) reviews constitutional
theory and shows how the 1973 decisions contained the seeds of more recent restrictions.
This is the only article to provide a feminist overview of the abortion decisions. For detailed

information on court cases and state laws through 1976; see Barbara J. Hayler, "Continuing Disparities in Access to Abortion: A Report from the Front after Nearly Four Years"
(paper presented at the 1976 meeting of the Northeastern Political Science Association,
South Egremont, Mass.). Current information on abortion law is available through the
Abortion Law Reporter, issued periodically by the Women's Rights Clinic, Antioch School of
Law, 1624 Crescent Place N.W., Washington, D.C. 20009. Also, for legal information, the
ACLU Reproductive Freedom Project, 22 E. Fortieth Street, New York, N.Y. 10016.

4. Roe v. Wade, 410 U.S. 113 (1973); Doe v. Bolton, 410 U.S. 179 (1973).

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Winter 1979 309

Signs

Parenthood of Central Missouri v. Danforth.5 This decision invalidated Mis-

souri's absolute parental and spousal consent requirements. Because a

woman physically bears the child and is the most directly and immediately affected by the pregnancy, the Supreme Court agreed that
her decision must prevail.
Danforth did not exclude the state from a woman's abortion decision
altogether. The Supreme Court has since upheld informed consent pro-

visions as legitimate state-imposed prerequisites; in general, such requirements have been struck down only when they are found to burden
the physician unduly.6 Massachusetts amended its pre-1973 abortion law
to require unmarried minors to obtain the consent of both parents, but

allowed a court to authorize an abortion if the pregnant minor was

found capable of giving informed consent or if "good cause" was shown
for the abortion. Several other states have adopted similar laws.7 On July

1, 1979, the Supreme Court clarified its position on consent re-

quirements by striking down the Massachusetts law, ruling that it imposed unconstitutional limits on a minor woman's right to choose abortion.8 Other states have recently enacted provisions requiring that notice
be given to husbands or parents to replace the invalidated consent re-

quirements. In May 1979, the Illinois House of Representatives approved a bill to permit a self-proclaimed biological father to obtain a
court order forbidding an abortion upon a showing of willingness to

support the child, even if the father is a convicted rapist and the preg-

nant woman is his victim.9

In 1977, the Supreme Court drastically reduced the availability of

abortion for poor women. The Court ruled that (1) Title XIX of the
Social Security Act (Medicaid) does not require states to fund nontherapeutic abortions, because states may refuse to fund "unnecessary"

medical services;10 (2) the Equal Protection Clause of the Fourteenth

Amendment does not require states to pay for nontherapeutic abortions,
even when they pay expenses incident to childbirth, because an indigent
5. Planned Parenthood of Central Missouri v. Danforth, 428 U.S. 52 (1976).
6. Bernice Karg, "Restrictions on Women's Right to Abortion: Informed Consent,
Spousal Consent, and Recordkeeping Provisions," Women's Rights Law Reporter 5 (Fall
1978): 35-51.
7. For an analysis of issues affecting minors, see Dara Klassel and Andrea Lewis,
"Minors' Right to Abortion and Contraception: Prospects for Invalidating Less than Absolute Restrictions," Women's Rights Law Reporter 4 (Spring 1978): 165-83; Barbara Freedman
Wand, "Parental Consent Abortion Statutes: The Limits of State Power," Indiana Law

Journal 52 (Summer 1977): 837-50; and John A. Siliciano, "The Minor's Right of Privacy:
Limitations on State Action after Danforth and Carey," Columbia Law Review 77 (December
1977): 1216-46.
8. Bellotti v. Baird, 47 U.S. Law Week, p. 4969.
9. Illinois, House of Representatives, H.B. 1202 as amended, approved by the Illinois
House of Representatives 81st General Assembly, on May 15, 1979.
10. Beal v. Doe, 432 U.S. 438 (1977).

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310 Hayler

Review: Abortion

woman still enjoys her right to seek abortion privately;11 and (3) a public
hospital may legally refuse to provide elective abortions even though it
provides other pregnancy-related services.12
These decisions represent a significant erosion of the right to choose
abortion as it was initially announced in 1973.13 In order to make this
shift, the Supreme Court had to accept several propositions. First, the
Court agreed that an abortion sought by a pregnant woman on the basis

of her needs rather than recommended by a doctor is "medically unnecessary."'4 Second, the Court held that the state has a strong and
legitimate interest throughout pregnancy in "encouraging normal
childbirth," that is, a legitimate right to "encourage" women, by means as
coercive as the denial of financial benefits, to stay pregnant and have
children. Third, the Court ruled that state refusal to fund elective abor-

tions placed "no obstacles-absolute or otherwise-in the pregnant

woman's path to an abortion." The state's decision to pay for childbirth,
but not abortion, supposedly leaves the indigent woman no worse off
than she would have been without Medicaid. According to this reasoning, it is her preexisting indigency, not the denial of benefits, that limits
her access to abortion. In summary, the Court found that only those laws
which absolutely prevent the exercise of the fundamental right to choose
abortion are unconstitutional; laws which "merely" make the exercise of
that right more difficult, in order to promote some desired public goal,
were accepted by the majority as a legitimate use of state power.15
The practical effect of these decisions is to make abortion a right for

women who can afford it and a privilege for the rest. The Hyde

Amendment,16 put into effect after these decisions, limits federal reimbursement to abortions performed when the pregnant woman's life is
endangered, when severe and long-lasting physical health damage to the
mother would result from a full-term pregnancy, or where the pregnant
11. Maher v. Roe, 432 U.S. 464 (1977); for Equal Protection arguments, which were
accepted by most lower courts, see "Case Developments, Abortion: Medicaid's Unwanted
Child," Women's Rights Law Reporter 3 (Fall 1975): 22-27.
12. Poelker v. Doe, 432 U.S. 519 (1977).
13. Nancy Gall-Clayton, "Beal, Maher and Poelker: The End of an Era?" Journal of
Family Law 17 (November 1978): 49-87.
14. Beverly Blair Cook, "Sex Roles and the Burger Court,"American Politics Quarterly 5

(July 1977): 353-94, argues that the Court is creating "a new doctrine of encapsulation"
which accepts "medical authority based upon technical expertise as the substitute for
husbandly authority based upon social competence."
15. Michael J. Perry ("The Abortion Funding Cases: A Comment on the Supreme
Court's Role in American Government," Georgetown Law Journal 66 Uune 1978]: 11911245) calls this a fallacious distinction.

16. The Hyde Amendment to the Labor and Health, Education, and Welfare appropriations bill, named for prime sponsor Rep. Henry Hyde and adopted each year since
1976, has severely restricted the use of federal funds for abortions for indigent women (for

background information and implementing regulations, see Federal Register, vol. 43

[February 2, 1978], p. 4570, and ibid. [uly 21, 1978], p. 31868).

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Winter 1979 311

Signs

woman is a victim of rape or incest. Although low-income women are

most severely affected by these restrictions, the rights of all women are
reduced by this failure to give substance to the guarantees of Roe and
Doe.

Many contemporary writers treat abortion as an act which can be

understood only on its own terms. But two studies of abortion and birth
control practices in America conclude that public policies in these areas
are interconnected and that both are affected by society's attitudes to-

ward women. James Mohr examines the process by which abortion,

widely accepted throughout the country in the early decades of the
nineteenth century, was proscribed and punished by criminal law in
virtually every state by 1900.17 This sudden reversal of custom was not
due primarily to a religious or moral movement; indeed, many religious
leaders shared the nineteenth-century-view that early abortion was an

acceptable form of birth control. Instead, the evolution of American

abortion policy was bound up with the history of medical practice, and
the crusade against abortion was led by physicians. Mohr argues that the
change in attitudes toward abortion was brought about by a move among
"regular" (AMA-affiliated) physicians to professionalize the practice of
medicine, combined with nativist distrust of new immigrants by both

physicians and state legislators. The newly established AMA used the
abortion issue to encourage states to introduce legal sanctions against
"irregular" competitors and to support the AMA in its efforts to discipline physicians and control the practice of medicine. Barker-Benfield
points out that the criminalization of abortion coincided with "the
gynecological crescendo" which replaced midwives-who were relatively
sympathetic to women's desires to end unwanted pregnancies-with
male physicians and enabled men to take control of the procreative

function.18

Mohr documents the high incidence of abortion after 1840, due

partly to the increasing use of abortion by white, married, Protestant,
native-born women of the middle and upper classes. Regular physicians
played on nativist prejudice, arguing that native-born Americans would
soon be outbred by their immigrant inferiors unless abortions were pro-

hibited. Mohr notes that the antiabortion movement was characterized

by "a virulent, undisguised, and apparently effective anti-Catholicism"

and argues that Protestants' fear of being outnumbered by Catholics was
more important in criminalizing abortion than was Catholic opposition
17. James C. Mohr, Abortion in America: The Origins and Evolution of National Policy,

1800-1900 (New York: Oxford University Press, 1978).

18. G. J. Barker-Benfield, The Horrors of the Half-Known Life: Male Attitudes toward
Women and Sexuality in Nineteenth-Century America (New York: Harper & Row, 1976).

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312 Hayler

Review: Abortion

to abortion. Mohr also notes the conservative views about woman's place

and woman's nature held by most physicians. Seen as both unnatural

and socially dangerous, abortion was attacked as a gross violation of

"virtuous womanhood,"'9 because it was evidence that women had suc-

cumbed to male sensualism and the desire to gratify it without accepting

maternal responsibilities.
Mohr demonstrates that American criminal abortion laws were not

motivated primarily by concern for the physical danger of abortion;

although presented as "protective" legislation for women, they in fact
served male interests. But here, as elsewhere, his book disappoints by
failing to move beyond the unique circumstances of the nineteenth century to a consideration of the significance of those decisions for women
then and now.

Linda Gordon has produced a history of the birth control movement which succeeds as a work of feminist theory.20 It examines the
significance of birth control to women and the women's movement, as
well as the development of birth control as a concept and a social movement. Gordon offers relatively little information about contraceptive
techniques; she argues that birth control is more a result of social and
political influences than medical or technological capability. She does not
treat abortion as a separate issue but develops an analysis of attitudes
toward women and reproduction that is applicable to all forms of birth
control (defined as individual control over reproduction). Gordon points
out that the prohibition of birth control has been a means of enforcing
women's subjection to men. The existence and availability of abortion
mean that a woman need not be "born to have children."

Gordon shows that the central issue of the birth control movement

has been not contraception but the control of contraceptionreproductive self-determination.21 Control exercised solely by women,
without the intervention of physicians or other professionals, has been
opposed by patriarchal institutions consistently. The successful planned

parenthood movement of this century, for example, focused on the

family, not the individual woman, as the unit for reproductive decisions.

This focus implicitly denied the sexism and power imbalances of the
traditional family structure and thus helped to keep women locked into

traditional roles. Birth control in this context-as a means of family

planning-was acceptable because it supported women's "natural" roles.

The current feminist movement has rejected this male-dominated per19. The phrase is used by Sheila Rothman in Woman's Proper Place: A History of Chang-

ing Ideals and Practices, 1870 to the Present (New York: Basic Books, 1978), chap. 2.
20. Linda Gordon, Woman's Body, Woman's Right: A Social History of Birth Control in
America (New York: Grossman Publishers, 1976).
21. For further discussion of Gordon's analysis see Elizabeth Fee and Michael Wallace, "The History and Politics of Birth Control: A Review Essay," Feminist Studies 5 (Spring
1979): 201-15.

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Winter 1979 313

Signs

spective, defining a woman's right to control her reproductive capacity as

a central political issue. Opposition to women's demand for freedom of
reproductive choice reveals deep patriarchal anxiety about how women
may act when freed from the restraints of biological motherhood. Gordon argues that reproductive self-determination requires more than the
availability of contraception, for reproductive patterns are determined
by the feasible alternatives to motherhood.

II

By 1900 virtually all states had adopted criminal statutes which reg-

ulated or prohibited abortion. Opposition to abortion became the national policy, and all abortion legislation passed before 1965 reconfirmed
the restrictive policies that regular physicians had successfully obtained.
Despite these laws, American women continued to seek and obtain abortions in substantial numbers. In the 1960s, estimates of the annual
number of illegal abortions ranged from 200,000 to over 1 million.22
Abortion did not become a significant political issue, however, until

the 1960s, when a strong movement for reform-and later, repealbegan to develop. The reform movement combined several distinct
political and social concerns: the consequences of criminally punishing
abortion;23 state-imposed restrictions on the provision of medical care
and the dangers of illegal abortions;24 and feminist assertions of the
right of all women to control their reproductive capacities and thus to
have access to safe, legal abortion.25 Several states adopted reform legislation based on the American Law Institute's Model Penal Code, which

liberalized restrictions on abortion but imposed extensive procedural

requirements. The women's movement supported most of these reform
measures. Cisler's 1969 analysis clarified the feminist distinction between
reform of abortion laws, which accepts the need for some state regulation, and their repeal, which defines abortion as a woman's right and
rejects the idea that anyone can veto her decision or force her to bear a
child.26 By 1973 four states-Alaska, Hawaii, New York, and Washing-

ton-had adopted "near-repeal" statutes.27 Court challenges against

22. Reported in Mohr, p. 254.

23. Edwin M. Schur, Crimes without Victims: Deviant Behavior and Public Policy (Englewood Cliffs, N.J.: Prentice-Hall, Inc., 1965).
24. Lawrence Lader, Abortion II: Making the Revolution (Boston: Beacon Press, 1973).

25. Diane Schulder and Florynce Kennedy, Abortion Rap (New York: McGraw-Hill
Book Co., 1971); Claudia Dreifus, "Abortion: This Piece Is for Remembrance," in Seizing
Our Bodies: The Politics of Women's Health, ed. C. Dreifus (New York: Vintage Books, 1977);
and the Boston Women's Health Book Collective, Our Bodies, Ourselves, 2d ed. rev. (New

York: Simon & Schuster, 1976), pp. 216-20.

26. Cisler (n. 1 above), p. 276.
27. Patricia G. Steinhoff and Milton Diamond, Abortion Politics: The Hawaii Experience

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314 Hayler

Review: Abortion

existing legislation in many states culminated in the decisions of Roe v.

Wade and Doe v. Bolton. But in 1973, twenty-five states still permitted
abortion only when necessary to save or preserve the pregnant woman's
life.28 Post-1973 activities of the abortion reform/prochoice movement
have focused on the need to bring state laws into conformity with the
principles enunciated by the Supreme Court and to continue the effort
to make abortions freely available to all women regardless of age, class,
race, or marital status.
National public opinion polls began to include questions about abortion in the 1960s. In each annual survey since 1972, the National Opin-

ion Research Center (NORC) has asked standardized questions about

the conditions under which abortion should be legal. Arney and
Trescher, examining four years of NORC data, reported that over 80

percent of those questioned approved of abortion in cases involving the

mother's health, possible child deformity, and pregnancy due to rape
("hard" reasons), while slightly less than half approved of abortion for
reasons of poverty, illegitimacy, or parental desire not to have more
children ("soft" reasons).29 Noting a sharp increase in public support for
abortion shortly after the 1973 decisions followed by relative stability of
attitudes, Arney and Trescher concluded that the judicial decision did
more to legitimate public opinion than to change it. Blake drew similar
conclusions in her analysis of national survey data, pointing out that
opposition to abortion on request has declined from a high of 85 percent
in 1968 to approximately 60 percent in 1974.30 More recent nationwide
surveys conducted since 1976 show majority support for the Supreme
Court decision on first trimester abortion.31

Although some physicians have taken an active role in the abortion

movement, several studies have found that health care professionals

(Honolulu: University Press of Hawaii, 1977); Byron N. Fujita and Nathaniel N. Wagner,
"Referendum 20-Abortion Reform in Washington State," in Osofsky and Osofsky (n. 2
above); Alan F. Guttmacher, "The Genesis of Liberalized Abortion in New York: A Personal Insight," Case Western Reserve Law Review 23 (Summer 1972): 756-78.
28. Betty Sarvis and Hyman Rodman, The Abortion Controversy, 2d ed. (New York:
Columbia University Press, 1974); Pat Vergata et al. "Abortion Cases in the United States,"
Women's Rights Law Reporter 1 (Spring 1972): 49-55. On the impact of feminism on litigation strategy, see Janice Goodman, Rhonda Copelon Schoenbrod, and Nancy Stearns, "Doe
and Roe, Where Do We Go from Here?" Women's Rights Law Reporter I (Spring 1973):
20-38.

29. William Ray Arney and William H. Trescher, "Trends in Attitudes toward Abortion, 1972-1975," Family Planning Perspectives 8 (May-June 1976): 117-24.

30. Judith Blake, "The Supreme Court's Abortion Decisions and Public Opinion in
the United States," Population and Development Review 3 (March-June 1977): 45-62. For
earlier statistics, see Blake, "Abortion and Public Opinion: The 1960-1970 Decade," Science
171 (February 12, 1971): 540-49.
31. Summaries are available from NARAL (n. 1 above); for data from Western
Europe as well as America, see Connie de Boer, "The Polls: Abortion," Public Opinion
Quarterly 41 (Winter 1977-78): 553-64.

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Winter 1979 315

Signs

hold "deep-seated negative attitudes toward abortion."32 A 1974 study of

nurses in Tennessee found that only 40 percent approved of abortion

for "hard" reasons, and less than 25 percent approved of abortion on
request.33 The authors suggested that nurses, the "gatekeepers" of hospital services, might be more important than physicians in determining
access to abortion. Connecticut physicians interviewed in a study by
Pratt, Koslowsky, and Wintrob generally favored abortions but were
more supportive of those performed for medical reasons (and thus
compatible with their professional roles and identities) than those based
on the personal decision of the pregnant woman.34
Much of the leadership of the antiabortion movement is provided
by the Catholic religious hierarchy, but religious denomination is not, by
itself, a primary determinant of abortion attitude or behavior.35 Arney

and Trescher identified "degree of religious commitment" as a much

stronger determinant of abortion attitude than denominational identification. Skerry argued that differences in attitudes toward abortion
reflected divergent attitudes among social classes toward the family, and

that "the defense of traditional moral and sexual values underlies the

resistance to abortion reform."36 Granberg also concluded, on the basis

of NORC survey data, that opposition to abortion was part of a general

conservative approach to personal morality.37 Antiabortion attitudes

32. Ellen W. Freeman, "Abortion: Beyond Rhetoric to Access," Social Work 21

(November 1976): 484-87; R. A. Hudson Rosen, H. H. Werley,J. W. Ager, and F. P. Shea,

"Health Professionals' Attitudes toward Abortion," Public Opinion Quarterly 38 (Summer
1974): 159-73.
33. Gerry E. Hendershot and James W. Grimm, "Abortion Attitudes among Nurses
and Social Workers," American Journal of Public Health 64 (May 1974): 438-41.
34. Gail L. Pratt, Meni Koslowsky, and Ronald M. Wintrob, "Connecticut Physicians'
Attitudes toward Abortion," American Journal of Public Health 66 (March 1976): 288-90.
35. See the activities of the Bishops' Committee for Pro-Life Activities of the National
Conference of Catholic Bishops, particularly the 1975 Pastoral Plan for Pro-Life Activities

calling for the organization of political action groups in every congressional district
(George Dugan, "Catholic Bishops Approve a Plan to Mobilize Public Support against
Abortions on Request," New York Times [November 21, 1975], p. 19; Kenneth A. Briggs,
"Catholic Prelates Organizing a Drive against Abortions," New York Times [August 17,
1977], p. 1; "Catholic Bishops File Suit to Halt Paid-Abortion Law," Seattle Times [June 22,
1979], p. C1). An editorial in the Jesuit publication America ("The Bishops' Plan for ProLife Activities," America 133 [December 27, 1975]: 454-55) described the Roman Catholic
hierarchy as the most prominent force opposing abortion. Roman Catholic involvement in

the legislative process is documented in plaintiffs brief for McRae v. Califano, a suit
challenging the constitutionality of the Hyde Amendment (Lawrence Lader, "Abortion
Opponents' Tactics," New York Times January 11, 1978], p. 19; Laurie Johnston, "Law and
Religion Intermingled in Suit on Abortion Ban," New York Times [March 14, 1978], p. 37;

"Does the First Amendment Bar the Hyde Amendment? Symposium on 'McRae v.

Califano,' " Christianity and Crisis 39 [March 5, 1979]: 34-43).

36. Peter Skerry, "The Class Conflict over Abortion," Public Interest 52 (Summer

1978): 69-84.
37. Donald Granberg, "Pro-Life or Reflection of Conservative Ideology? An Analysis
of Opposition to Legalized Abortion," Sociology and Social Research 62 (April 1978): 414-29.

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316 Hayler

Review: Abortion

were not consistently associated with a "more generalized pro-life orientation" or conservative political views, but they were reliably correlated
with opposition to premarital sex, divorce, contraception, and sex education. Thus, antiabortion forces generally opposed social programs that

would make abortion less frequent. Gordon and Hunter argued that
opposition to abortion was linked to the defense of patriarchy-a system
based on male control of families-and motivated more by fear of women's independence than by concern for the unborn.38 Gordon concluded
that antiabortion forces "are reacting not merely to a 'loosening of mor-

als' but to the whole feminist struggle of the last century; they are
fighting for male supremacy."39
III

Research on the psychological effects of abortion is contaminated

because most studies have been based on the experiences of women who
underwent therapeutic abortions before 1973, when mental instability
was the primary legal justification. Pre-1973 research generally focused
on the incidence of postabortion psychopathology. Callahan, in a comprehensive work, has characterized this literature as "a conceptual desert,"40 while Sarvis and Rodman commented on the "peculiar mixture
of, first, belief that women violate taboos by having an abortion and
therefore should suffer some aftereffects and, second, evidence on the
nature and extent of the psychological and physical aftereffects."41 Most
research on the effects of abortion tells us more about the ideological
attitudes of the researcher than the reality of abortion. For example,
Francke reported a 1972 Australian study which concluded that postabortion depression stemmed from a woman's sense of failure and in-

adequacy at not being "allowed" to carry out one of the tasks of her

feminine role.42 Lisa Shusterman, in the most extensive review of this

literature to date, argued that there has been no high-quality study to
support the conclusion that therapeutic abortion produces negative psychological reactions in women.43 In fact, studies of abortion on request

show the psychological consequences to be mostly benign. Studies by

Adler, Addelson, Smith, and Osofsky, based on interviews with women
38. Linda Gordon and Allen Hunter, "Sex, Family and the New Right: Anti-Feminism
as a Political Force," Radical America 11, no. 6/12, no. 1 (November 1977/February 1978):
9-25.

39. Gordon (n. 20 above), p. 415.

40. Daniel Callahan, Abortion: Law, Choice, and Morality (New York: Macmillan Co.,

1970), p. 72.
41. Sarvis and Rodman (n. 28 above), p. ix.
42. Reported in Linda Bird Francke, The Ambivalence of Abortion (New York: Random

House, 1978), p. 42.

43. Lisa Roseman Shusterman, "The Psychosocial Factors of the Abortion Experience: A Critical Review," Psychology of Women Quarterly 1 (Fall 1976): 79-106.

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Winter 1979 317

Signs

who had had abortions, all concluded that the predominant emotional
responses were relief and happiness, although they might be combined
with some negative feelings.44 These findings were confirmed in
Franke's The Ambivalence ofA bortion, based on interviews with women who

had had abortions and people who had gone through the experience

with them.45

A review of abortion literature by the National Academy of Sciences

in 1975 compared the psychological and physiological complications associated with abortion with those associated with full-term pregnancy
and concluded that abortion, particularly during the early months, was
less dangerous.46 Statistics gathered by the Department of Health, Education, and Welfare's Center for Disease Control show that first-

trimester abortions (now more than 85 percent of all abortions per-

formed in the United States) are twelve times safer than childbirth, and
that only those abortions performed in the sixteenth week or later (ap-

proximately 7 percent of all abortions) are more dangerous than

childbirth.47

The long-term physical effects of abortion on future pregnancies

are still unclear. Most studies of adverse effects have been done in other

countries and the evidence they provide is contradictory. However, one

longitudinal study from the United States found that previous abortions
were not related to low birth weight, premature delivery, stillbirth,
neonatal death, miscarriage, or congenital defects in subsequent pregnancies.48 The medical profession has expressed concern over the possible dangers of abortion but has given scant attention to the risks of oral
contraceptives. According to Sarvis and Rodman, "ideological biases ...

have built a molehill out of the dangers stemming from oral con44. Nancy E. Adler, "Emotional Responses of Women Following Therapeutic Abor-

tion," American Journal of Orthopsychiatry 45 (April 1975): 446-54; Frances Addelson, "Induced Abortion: Source of Guilt or Growth?" American Journal of Orthopsychiatry 43 (Octo-

ber 1973): 815-23; Elizabeth M. Smith, "A Follow-Up Study of Women Who Request
Abortion," American Journal of Orthopsychiatry 43 (July 1973): 574-84; J. Osofsky, H.
Osofsky, and R. Rajan, "Psychological Effects of Legal Abortion," Clinical Obstetrics and
Gynecology 14 (1971): 215-34.
45. In contrast, see Magda Denes, In Necessity and Sorrow: Life and Death in an Abortion

Hospital (New York: Basic Books, 1976), also based largely on interviews and personal
observations but focused on the pain of the abortion experience.
46. Institute of Medicine, Legalized Abortion and the Public Health (Washington, D.C.:
National Academy of Sciences, May 1975).

47. Willard Cates, Jr., and Christopher Tietze, "Standardized Mortality Rates Associated with Legal Abortion: United States, 1972-1975," Family Planning Perspectives 10
(March-April 1978): 109-12; statistics on abortion-related mortality are published annually in CDC's Abortion Surveillance Report (n. 1 above).
48. Janet R. Daling and Irvin Emanuel, "Induced Abortion and Subsequent Outcome

of Pregnancy in a Series of American Women," New England Journal of Medicine 297

(December 8, 1977): 1241-45; but see also a study by the National Institutes of Health
reporting a tendency to more miscarriages and other problems in subsequent pregnancies
(untitled artide by Trudy Tynan, New York Times [August 11, 1978], p. 56).

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318 Hayler

Review: Abortion

traceptives and a mountain out of the dangers stemming from abor-

tion."49

Although abortion is recognized as stressful, and counseling is recommended as a part of the procedure, relatively little attention has been
given to the actual decision to terminate an unwanted pregnancy. There
have been psychiatric studies of abortion patients which focus on the
identification of personality characteristics in women as causes or effects
of the abortion experience. The psychiatric bias remains strong today:
In 1977 when Rothstein explored the abortion decision in terms of the
couple's relationship, he felt it necessary to emphasize that "the request
for abortion by no means reflects or provokes pathology."50 This bias in
medical research may also reflect the limited involvement of physicians
in the actual abortion decision. A Michigan study of women who ultimately obtained abortions found that only 17 percent first turned to
their regular doctor for advice when they thought they might be pregnant, and only 41 percent went to their doctor to find out whether they
were pregnant.51
Two recent studies have examined abortion from a sociological per-

spective. Zimmerman concluded that whether a woman experienced

abortion "smoothly" or as a major disruption depended on the circumstances of abortion passage: her social roles, her "affiliation" or integration into her social world, the reactions of others, and the type of facility
where the abortion was performed.52 Kristin Luker reviewed clinical
records and interviewed sixty women in an attempt to understand why

significant numbers of women seeking abortions had not used contraceptives to prevent pregnancy.53 She argued that erratic contraceptive use and unintended pregnancy might not be irrational when viewed
from the perspective of the women themselves. There were social costs
associated with contraception, and women had to choose between "being
prepared" or risking an unwanted pregnancy. Ryder estimates that one
out of every three couples using reversible contraceptive methods will
have an unwanted pregnancy within five years.54 Contraceptive failure
49. Sarvis and Rodman, p. 140; also Christopher Tietze, "Mortality with Contraception and Induced Abortion," Studies in Family Planning 45 (September 1969): 6-8.
50. Arden Rothstein, "Abortion: A Dyadic Perspective," American Journal of Orthopsychiatry 47 (January 1977): 111-18.
51. Raye Hudson Rosen, "The Patient's View of the Role of the Primary Care Physician in Abortion," American Journal of Public Health 67 (September 1977): 863-65.
52. Mary K. Zimmerman, Passage through Abortion: The Personal and Social Reality of
Women's Experiences (New York: Praeger Publishers, 1977).
53. Kristin Luker, Taking Chances: Abortion and the Decision Not to Contracept (Berkeley:

University of California Press, 1975); also Ellen W. Freeman, "Abortion: Subjective Attitudes and Feelings," Family Planning Perspectives 10 (May-June 1978): 150-55.
54. Norman B. Ryder, "Contraceptive Failure in the United States," Family Planning
Perspectives 5 (Summer 1973): 133-42. Francke's interviews included women who had
become pregnant while using contraceptives.

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Winter 1979 319

signs

may stem from defective contraceptives, defective instructions, or a defective system of health care delivery, as well as "patient failure." William
Ryan has noted that the common tendency to hold women responsible is
a classic case of "blaming the victim."55

IV

Abortion has consistently been less readily available to and more

dangerous for poor and minority women in this country. Shockingly few

studies of the extent of this problem or its consequences have been

published. A 1971 law review article analyzed the available data and

concluded that "restrictive abortion laws create a double standard in the

treatment of private and indigent patients."56 Under the abortion laws in

effect before 1970, at least 80 percent of all therapeutic abortions were
performed on private hospital patients, who were predominantly white
and affluent. In New York City during the early 1960s, 93 percent of the
therapeutic abortions were performed on white private patients.57 Sarvis
and Rodman summarized evidence from studies of the 1950s and 1960s

showing higher rates of abortions for private patients than for public or
general service patients, and for white than for minority women. Much
more limited evidence suggests that the white and the affluent also had

preferential access to illegal abortions, particularly those performed

clandestinely by physicians. Abortion-related mortality rates for blacks
have consistently been much higher than those reported for whites.58
How have poor and minority women fared under the reform laws
of the 1970s? There is some evidence that their access to abortion has

increased. In one of the few studies of abortion to focus directly on race,

Kramer found that the legal abortion rate of blacks in New York City
under the 1970 reform law was double the rate of whites.59 This represented a sharp increase over the prereform rate and indicated that black
women were willing to use abortion to terminate unwanted pregnancies
when abortion was available and voluntary. The availability of abortion
55. William Ryan, Blaming the Victim (New York: Pantheon Books, 1971).
56. Alan Charles and Susan Alexander, "Abortions for Poor and Nonwhite Women:

A Denial of Equal Protection?" Hastings Law Journal 23 (November 1971): 147-69.

57. Theodore Irwin, "The New Abortion Laws: How Are They Working?" Today's
Health 48 (March 1970): 21-23; Harriet Pilpel, "The Abortion Crisis," in The Case for
Legalized Abortion Now, ed. Alan Guttmacher (Berkeley: Diablo Press, 1967).
58. Sarvis and Rodman, chap. 9.
59. Marcia J. Kramer, "Legal Abortion among New York City Residents: An Analysis
according to Socioeconomic and Demographic Characteristics," Family Planning Perspectives

7 (May-June 1975): 128-37. Willard Cates, Jr., reported the same rate nationally after
legalization in 1973-74, although black women express greater disapproval of abortion

than white women ("Abortion Attitudes of Black Women," Women and Health: Issues in
Women's Health Care 2 [November-December 1977]: 3-9).

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320 Hayler

Review: Abortion

in clinics and public hospitals has been particularly important to black

women. However, statistics on abortion providers collected by the Alan
Guttmacher Institute show that abortions are still not readily available

outside metropolitan areas. An institute study concluded that "requirements of extensive travel to obtain abortions impose barriers of
cost, time and sophistication that especially disadvantaged poor, rural,

young and black women."60 Black women have also been dis-

proportionately affected by the adoption of the Hyde Amendment

(1977), which imposed restrictive conditions on Medicaid reimburse-

ment for abortions: Federally funded abortions for low-income women

dropped from an estimated 250,000 annually to about 2,400 in 1978.61

Officials of the CDC conclude that the Medicaid ban will produce an
increase in the number of abortion-related deaths and a higher level of
complications from illegal abortion, pregnancy and childbirth, and will

impose enormous social and financial costs on poor women and their

families.62

Forced motherhood and forced sterilization are two sides of the

same coin: Each policy "blatantly exhibits the arbitrary power exercised
by physicians and hospitals."63 For middle-class white women, the primary issue connected with sterilization has been the refusal of hospitals
to permit voluntary sterilizations; for poor and minority women the
primary issue has been the genocidal implications of involuntary, compulsory sterilization.64
Several studies have shown that most physicians-well over 90 per-

cent in some surveys-favor compulsory sterilization for a welfare

mother with three or more illegitimate children.65 A recent federal court

decision noted that there was "uncontroverted evidence" that "an in-

definite number of poor people have been improperly coerced into accepting a sterilization operation under the threat that. .. benefits would
60. Jacquelin Darroch Forrest, Christopher Tietze, and Ellen Sullivan, "Abortion in
the United States, 1976-77," Family Planning Perspectives 10 (September-October 1978):

271-79.

61. Spokeswoman 9 (March 1979): 4. Richard Lincoln, Brigitte Doring-Bradley, Barbara L. Lindheim, and Maureen A. Cotterill, "The Court, the Congress and the President:

Turning Back the Clock on the Pregnant Poor," Family Planning Perspectives 9
(September-October 1977): 207-14.

62. Diana B. Petitti and Willard Cates, Jr., "Restricting Medicaid Funds for Abortions:
Projections of Excess Mortality for Women of Childbearing Age," AmericanJournal of Public

Health 67 (September, 1977): 860-62.

63. Sarvis and Rodman, p. 177.
64. Edward J. Spriggs, Jr., "Involuntary Sterilization: An Unconstitutional Menace to
Minorities and the Poor," New York University Review of Law and Social Change 4 (Spring
1974): 127-51.

65. Judith Herman, "Fighting Sterilization Abuse," Science for the People 9 (JanuaryFebruary 1977): 17-19; Note, "MDs Assume Poor Can't Remember to Take Pill," Family
Planning Digest 1 (January 1972): 3.

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Winter 1979 321

Signs

be withdrawn."66 Sarvis and Rodman noted the paucity of research in

this area, but confirmed that many physicians and hospitals refuse to

provide abortions to indigent women unless they also agree to be

sterilized in what is commonly referred to as "the package deal."67 Federal policies support these practices by simultaneously restricting abor-

tion, which promotes reproductive self-determination and fostering

sterilization, which gives reproductive control to physicians. The most

extreme consequences of these policies can be observed in Puerto Rico,
where over 35 percent of the women between twenty and forty-nine
years of age are now sterilized.68
V

The right to choose abortion-as part of a claim to reproductive

self-determination-is central to the feminist movement. The im-

portance to patriarchy of asserting male control and ownership of women's reproductive capabilities, and of denying that control to women, has
been analyzed in much of the feminist literature. I would like to draw
attention to the way in which feminist theory helps us understand the
character of antiabortion sentiment today.
In her study of motherhood, Adrienne Rich examines the violence

of institutionalized motherhood.69 Institutionalized motherhood de-

mands of women not self-conscious intelligence and commitment but

maternal "instinct," and submission to the "natural" order of things. Not

all motherhood is praised, nor all maternal instincts approved-only

those that serve patriarchal institutions. "Motherhood is 'sacred' so long
as its offspring are 'legitimate'-that is, as long as the child bears the
name of a father who legally controls the mother." Women who deprive
their children of a father are viewed as selfish, unnatural, condemnable,
just as women who deprived their husbands of children by birth control

or abortion were viewed as unnatural and immoral in the nineteenth

century.
66. Relf v. Weinberger, 372 F.Supp. 1196 (D.D.C. 1974), at 1199.
67. Sarvis and Rodman, chap. 10; Gena Corea, The Hidden Malpractice: How American
Medicine Treats Women as Patients and Professionals (New York: William Morrow, 1977),

chap. 10.
68. Ad Hoc Women's Studies Committee against Sterilization Abuse, Workbook on
Sterilization and Sterilization Abuse (Bronxville, N.Y.: Women's Studies, Sarah Lawrence
College, 1978); Bonnie Mass, Population Target: The Political Economy of Population Control in

Latin America (Toronto: Canadian Women's Educational Press, 1977). Susan Bram argues
that concern over high fertility rates is a response to high fertility among those seen as
undesirable members of the community ("Women and Children First, or How Pop Planning Fucked over Mom," Heresies 2 [Summer 1978]: 65-73).
69. Adrienne Rich, Of Woman Born: Motherhood as Experience and Institution (New York:

W. W. Norton & Co., 1976), p. 24.

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322 Hayler

Review: Abortion

In patriarchal society, the basic female principle is passivity. Conception and motherhood are no exceptions: Woman's role in conception
is to receive and to incubate; woman's role in motherhood is to be selfless
and giving, to meet familial needs and demands. Feminist theory has
begun to explore the damage done to women by this denial of self. Mary
Daly suggests that enforced passivity may properly be viewed as a form
of gynocide; involving the domestication and deprivation of female vitality and the destruction of women's autonomous wills.70
Abortion makes it possible for women to resist forced motherhood.
The issue of control of reproductive power is central to the abortion
controversy. Many of the authors discussed in this essay have argued
that opposition to abortion is only one aspect of a broader opposition to
female autonomy generally. In a patriarchal society where male identity
is largely based on power over women, changes in power relationships
are indeed disturbing. One physician explained the perceived threat in
this way: "The pregnant woman symbolizes proof of male potency and if

the male loosens his rule over women and grants them the right to
dispose of that proof when they want to, the men then feel terribly
threatened lest women can, at will, rob them of their potency and masculinity."71

As Mary Daly points out, "It is the condition of all males to be

childless."72 Men's necessary dependence on women for their biological

reproduction has been used to justify male control over women's reproductive capacities. In a patriarchal, patrilineal society, women's chil-

dren are guarantees of men's immortality. Several authors reviewed

here argue that male opposition to abortion stems in part from the fear

that, given a truly free choice, many women would elect not to have
children. This fear implies recognition of the unequal distribution of
parenting responsibilities and the enormous social and personal costs
imposed on women by the current arrangements.73 It also reflects the
continuing power of the patriarchal view of woman as whore-selfish,
amoral, and socially irresponsible. The fear that women will abuse their
reproductive freedom suggests that the archetypal castrating bitch has
become a destructively rapacious creature-a Medea in modern dress.
In a chilling analysis, Marvin Kohl argues that the "sanctity-of-life" argument against abortion derives from "the most deadly anti-woman bias
of them all, namely: that unless women are carefully controlled they will
70. Mary Daly, Gyn/Ecology: The Metaethics of Radical Feminism (Boston: Beacon Press,

1978), p. 245.
71. George S. Walter, "Psychological and Emotional Consequences of Elective Abortion,"Journal of Obstetrics and Gynecology 36 (September 1970): 483, quoted in Corea, p. 16.

72. Daly, p. 59.

73. Dorothy Dinnerstein, The Mermaid and the Minotaur: Sexual Arrangements and
Human Malaise (New York: Harper & Row, 1976).

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Signs

Winter

1979

323

kill their own progeny without reason because they are not fully rational

creatures."74

It has only been ten years since the topic of abortion was practically

taboo outside the health field. Now that a sizable body of literature
exists, we must begin to develop the kinds of theoretical perspectives that

will provide assistance in evaluating this information. Recent works

suggest that such a perspective may draw as much on our understanding

of personal power and social structure as it does on the study of reproduction and motherhood.
SocialJustice Professions Program
Sangamon State University
74. Marvin Kohl, The Morality of Killing: Sanctity of Life, Abortion and Euthanasia (New

York: Humanities Press, 1974).

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