Brittany, a college student whose injectable birth control failed, had an easier time: She only had to walk through a mob of clinic protesters who showered her with baby-doll parts painted red. Wandalyn, an impoverished undocumented immigrant whose fetus was diagnosed with a serious genetic condition, needed almost a dozen helpers to end her pregnancy: volunteer drivers who took her on several two-hour round trips to the clinic (on her first visit, it was closed for one of many surprise inspections), a host to put her up for the night and donors to pay for the procedure.
These and many other real-life stories recounted in “Obstacle Course: The Everyday Struggle to Get an Abortion in America” show how hard it has become in much of the United States for women, especially low-income ones, to end a pregnancy. Since the Roe v. Wade Supreme Court decision in 1973, more than 1,200 restrictions have been passed at the state and federal levels, more than a third of them since Republicans swept into power in state legislatures in 2010. Although some blue states — California, Maine and New York — have passed laws favoring abortion rights, in most others it’s only getting harder: As authors David S. Cohen and Carole Joffe note, 42 percent of women now live in states that are hostile or very hostile to abortion. Recently, in response to the coronavirus pandemic, several states have closed or tried to close their abortion clinics, designating them as “nonessential” medical services. A Supreme Court decision due this year in June Medical Services v. Russo could overturn Roe or permit restrictions that would render it useless.
Even if you think you know a lot about abortion, “Obstacle Course” will be a wake-up call. Joffe, a sociologist, and Cohen, a law professor, lay out in energetic, readable prose just about every roadblock facing abortion patients, providers, allies and volunteers at every step of the way. Abortion is too often treated as an abstraction. The authors present the actual experience, and in doing so reveal the courage, intelligence and determination of patients, often dismissed as confused or selfish, and providers, often attacked as heartless and greedy.
The book describes the many myths about abortion that have shaped our laws and have even crept into the voices of some of those who defend a woman’s right to choose. Parental notification and consent laws are popular among well-meaning adults who believe that teenagers are too immature to make this big decision on their own. But what if the parents are unavailable, like Talia’s, or are troubled, abusive, unable or unwilling to help their daughter? Moreover, if a girl is too immature to choose abortion without parental involvement, why is the default assumption that she is mature enough to have a baby?
There’s the myth that women are uncertain about their decision — the rationale that’s behind waiting periods that increase the procedure’s costs and can cause dangerous delays, and that requires doctors in several states to read a script intended to discourage patients from going ahead with the procedure. In some states, that means telling them falsehoods, such as that abortion causes breast cancer.
There’s the myth of abortion regret. But a study published in January and conducted by Advancing New Standards in Reproductive Health, a research group at the University of California at San Francisco, found that more than 95 percent of women who had an abortion were content with their decision five years later.
There’s the myth that providers are incompetent and abortion is dangerous. As the authors write, “Abortion is safer than childbirth, vasectomy, plastic surgery, colonoscopy, and liposuction.” They add that a woman is 14 times more likely to die during childbirth than during an abortion, 10 times more likely to die because of a colonoscopy and 28 times more likely to die because of liposuction. “All in all,” they write, “abortion has a stellar safety record, as a landmark study released in 2018 by the National Academies of Sciences, Engineering, and Medicine concluded.”
And let’s not forget the myth that abortions are just a matter of convenience — looking good in a bathing suit, taking a fancy vacation. If abortion were such a casual matter, it is hard to imagine that more than 800,000 American women a year would endure so much trouble, humiliation and expense to get one. “Women will walk over hot rocks to find an abortion provider,” one provider told the authors. As “Obstacle Course” demonstrates, too often that is what they have to do.
In “Abortion and the Law in America: Roe v. Wade to the Present,” law professor Mary Ziegler meticulously charts the twists and turns of abortion law over the past 47 years, paying special attention to the organized groups on each side. She outlines the two grounds that underpin the debate. One centers on the question of rights: a woman’s individual right to decide vs. the right to life of a fertilized egg, embryo or fetus. The other arises over social policy: What is the effect of legal abortion on women, men, children, society? In the lead-up to Roe and in its aftermath, rights-based arguments were dominant and favored abortion rights supporters.
Abortion opponents spent years in a futile quest to pass the Human Life Amendment, which would have enshrined the personhood of the fetus in the Constitution and banned all abortion. An internal struggle over whether to give up on that amendment and focus on chipping away at abortion access on social policy grounds, focusing on women’s safety and well-being, parental rights, fathers’ rights and other issues, nearly destroyedthe antiabortion movement, but eventually the pragmatists won. Although their goal is absolutist — criminalization of all abortion in the name of fetal rights — the strategy is incremental. Today, the battle in the courts, and in public opinion, is over regulation: passing laws in the name of women’s health that make abortion harder to get and that, ideally, force clinics to close.
This antiabortion strategy has presented a problem for abortion rights groups. Their members and donors have been much more excited by rights-based arguments — direct threats to Roe — than by the ongoing drip, drip, drip of antiabortion state regulations: waiting periods, biased counseling, laws that force clinics out of business by burdening them with expensive and unnecessary rules. Even the Hyde Amendment, which banned federal Medicaid payments for abortion, was tacitly accepted by the pro-choice side until quite recently. As long as Democratic presidents were in power, abortion rights supporters inaccurately thought that abortion rights were safe.
Ziegler walks readers through the legal thickets of the post-Roe era, and it’s a sobering journey. Abortion rights advocates won last-minute semi-victories, only to have them pave the way for antiabortion wins later. In 1992, for example, Planned Parenthood v. Casey came as a big relief to abortion rights supporters because it reaffirmed Roe. But it also contained Justice Sandra Day O’Connor’s “undue burden” test for deciding what abortion restrictions were permissible. Under that test, a state legislature cannot pass laws that are too burdensome on or restrictive of basic rights. That standard left open many avenues to hinder a woman’s access to abortion. The question now arose: What is a burden? And what does “undue” mean? Isn’t any burden undue for someone, somewhere? The Casey decision upheld Pennsylvania’s laws mandating parental consent, biased counseling and a 24-hour waiting period. But why should the right of Talia, Brittany and Wandalyn to end their pregnancies have been subjected to a test at all?
In “Policing the Womb: Invisible Women and the Criminalization of Motherhood,” the law professor Michele Goodwin supplies a comprehensive, excoriating analysis of the many ways the law — to say nothing of medicine, the news media and social convention — coerces women, especially poor women of color, who confront issues of pregnancy, maternity and sex. Goodwin is radical: She argues that women’s bodies are treated as the property of the state and of men, who make up the large majority of legislators and who write and apply the laws.
She marshals her evidence with the passion of a crusading lawyer, and the results are devastating. We learn that at least two dozen states prohibit removing life support from pregnant women. The book recounts the gruesome story of Marlise Muñoz, whose brain-dead, pregnant body was artificially maintained in a Texas hospital even as it rotted, in delusional hopes of producing a live baby. We learn that hundreds of women have been arrested, and some imprisoned, for their behavior during pregnancy, even when their babies were born healthy. That women are still being forced to have C-sections they don’t want. That the extremely light sentence Judge Aaron Persky gave Stanford swimmer Brock Turner, convicted of rape in a sensational trial in 2016, was not an unusual one for respectable white men. I was familiar with a lot of Goodwin’s material, but seeing it collected together is startling.
Goodwin shows us that it’s not just poor women and women of color whose rights are disregarded. She describes a talk she gave at a gathering of wealthy conservative women in Orange County, Calif., where woman after woman told of being bullied by her obstetrician into following his orders, sometimes including a threat to call the police. One doctor refused to treat a woman having a miscarriage for religious reasons, because it would mean ending the pregnancy. “It became clear to each of us that any woman could potentially be vulnerable to surveillance, policing, and criminalization during pregnancy, even in California, a state that embedded a woman’s right to reproductive privacy in its constitution.”
“Policing the Womb” contains the best explanation I’ve read for the necessity of reproductive justice, not just reproductive rights. Focusing on the right to choose abortion doesn’t get at the full range of cruelty, unfairness and misogyny visited upon women in courtrooms, prisons, gynecologists’ offices and hospitals. It doesn’t explain why we are quick to imprison mothers for drug offenses, even though their children suffer greatly, or why the U.S. maternal mortality rate is the highest in the industrialized West, especially for black women, and rising. It doesn’t explain why, after making abortion so hard to get, we offer mothers so little help, even as we deplore the high child poverty rates in an affluent nation like ours.
If you thought the United States was becoming friendlier to women, a more equal and just place, this book will disabuse you of that illusion. In some ways, it is getting more hostile and punitive. For anyone interested in the American reality for many women, “Policing the Womb” is essential reading.
The Everyday Struggle to Get an Abortion in America
By David S. Cohen and Carole Joffe
University of California. 272 pp. $24.95
Abortion and the Law in America
Roe v. Wade to the Present
By Mary Ziegler
Cambridge. 312 pp. $29.99 paperback
Policing the Womb
Invisible Women and the Criminalization of Motherhood
By Michele Goodwin
Cambridge. 323 pp. $29.99