Reproductive Freedom in the 21st Century

By Alexander Sanger

PublicAffairs. 340 pp. $26

In the early part of the past century, Margaret Sanger, founder of the modern birth control movement, did a very clever thing. At the time, the notorious Comstock laws barred the use of contraceptives (or dissemination of contraceptive information) except to prevent disease, a loophole that permitted men to use condoms when visiting prostitutes. In a series of court cases, Sanger, a nurse, marshaled example after moving example of women dying in childbirth to argue that pregnancy, too, should be seen as a kind of illness, a real threat to women's health from which they should be permitted to protect themselves. Her reasoning eventually proved not only persuasive but transforming: As her grandson Alexander Sanger shows in "Beyond Choice," for years health would be the prevailing rationale behind the reproductive rights movement. It was only later that the twin notions of "privacy" and "choice" took over.

Now Alexander Sanger wants to bring back the pregnancy-as-disease argument, as a way of saving the reproductive rights movement from its current rather battered state. There's no doubt that abortion rights advocates need a new rationale, a fresh and persuasive argument. While the recent rally on the Mall shows the deep support that remains for both legalized abortion and contraception, the very occurrence of the march suggests that abortion rights adherents are rattled by the antiabortion movement's recent legislative successes. With the Unborn Victims of Violence Act, in particular, the antiabortion movement has succeeded in elevating the status of the fetus, creating legal justification for the argument that even early life has rights. At the same time, medical science in the form of ultrasound is making that life visible to all, causing many Americans, regardless of ideology, to rethink their views on the fetus. As William Saletan argued in a recent article on, the challenge now for the pro-choice movement is to show that it's not just woman-friendly but child-friendly; it must find a way to bring the idea of "family" back into family planning.

For Sanger, the solution lies in the field of evolutionary biology. Like many contemporary thinkers, he seems to have had a bit of a eureka moment in exploring this trendy academic field, which holds that people are motivated, in pretty much everything they do, by the urge to reproduce. Sanger argues that abortion does serve this aim; although it's a little counterintuitive, he argues that terminating a pregnancy can serve the overall aim of procreation. We are all, he writes, reproductive strategists now; we all want to reproduce successfully, and abortion can help us get there by ensuring (1) that a woman doesn't have too many children too close together, which is unhealthy for her and for them; and (2) that she doesn't have to bear a child under adverse circumstances. Abortion, he contends, often happens when a woman has chosen the wrong partner or gotten pregnant at the wrong time. It lets her "get back in the game" and conceive under better conditions.

In short, Sanger is arguing, a little coldbloodedly, that sacrificing a potential child is sometimes necessary for children and families in general to flourish. Treading rather carefully, he concedes the antiabortion point that unborn life is life, but goes on to argue that this life can and does at times represent a threat to other lives, a challenge to the mother's health and to the existing family order.

"While abortion takes life, it enables life to reproduce itself successfully, not on nature's terms but on human terms," he writes. "The unborn child is not just an innocent life. While it is the epitome of human destiny and the greatest potential joy that humanity can create, it is also a liability, a threat, and a danger to the mother and to the other members of the family. In order to survive, humanity has necessarily taken pre-born life to preserve other life all throughout its evolutionary history."

Abortion seen this way is a kind of Malthusian event, a necessary corrective whereby some children are erased for the bulk of humankind to flourish.

Sanger has dedicated his career to the cause his grandmother started, working as president of Planned Parenthood of New York City and elsewhere in the family-planning movement. His book is at its best, I think, when it describes his experiences watching women undergo abortions and listening to their reasons. He is honest in acknowledging that legalized abortion has had unintended consequences: For example, it gives men an excuse to abandon a pregnant partner and, in some countries, has permitted the widespread extermination of girls. Overall, however, he believes that abortion is an important way in which women, and men, can assert dominion over nature, control their reproduction and ensure that the children they do have grow up healthy.

Certainly, his is a bold attempt to forge a genuine new argument, one that's true to his grandmother's reasoning but adjusted to the present day. I am not sure, though, that it's going to work as a general philosophy. The idea that "some babies must die so that others might live" hardly seems likely to galvanize a new activist generation.

Today, in most countries, pregnancy and childbirth are safer than ever, in large part thanks to the efforts of Margaret Sanger and her like; to argue that pregnancy represents a health risk, her grandson has to resort to statistics from selected Third World nations. It might have helped if he'd included examples like that of a friend of mine: a devoted mother of three children who, upon unexpectedly becoming pregnant, felt, with anguish, that she could not be mother enough to four children. That, I think, is the kind of circumstance under which abortion is carried out -- regretfully -- for the sake of family life.

Sanger also doesn't consider an obvious objection. For his argument to work, abortion needs to be part of an overall childbearing strategy. The later babies need to materialize. So what about women who have abortions but never have children? What about those boyfriends who, as he acknowledges, sometimes pressure women into having abortions? What about women who find that, having used contraceptives too long, they are now too old to conceive? How do they fit the abortion-is-good-for-families theory?

Still, one central plank of Sanger's argument rings true: the notion that controlling our reproduction, and subduing nature, is part of what separates humankind from other species. Directing our childbearing is one reason the human race has successfully evolved.

It would be a disaster, he points out, if every procreative act developed into a child. I think that many people agree with his larger point: While they may not like the idea of abortion, the majority of Americans, studies show, still feel that it serves the greater good when a woman can make her own difficult childbearing choices. But "Beyond Choice" also reminds us that the mother's gain is sometimes the baby's loss and that human reproduction, as it moves forward, still carries with it some very hard trade-offs.