1
Introduction

Todd Akin was running to represent Missouri in the US Senate in 2012. A former IBM salesman and steel mill manager, Akin had a quarter century of experience as a politician, serving twelve years in the Missouri House of Representatives, then another twelve years in the US House of Representatives. His campaign for the next step in his long political career, to become a US Senator, was going well. He was running as a conservative Republican in a state that had increasingly voted for Republican candidates in recent elections. He had the strong support of the conservative Tea Party movement and national conservative groups who were spending millions of dollars on his behalf. His opponent, Democrat Claire McCaskill, was considered one of the most vulnerable Senate incumbents in the nation.

Just over two months before the election, Akin was interviewed by local Fox Network affiliate KTVI in St. Louis, during which host Charles Jaco asked him about his abortion views: “What about in the case of rape? Should it be legal or not?” Akin, who had been an activist in the pro-life movement even before his political career, repeated his longstanding position that abortion should be illegal even when a pregnancy is the result of rape. In explaining this position during the interview, he suggested both that some women may falsely claim rape to obtain an abortion and that female physiology made pregnancy as a result of rape extremely rare. “If it’s a legitimate rape,” Akin said, “the female body has ways … to shut that whole thing down.”

His remarks set off a national firestorm of controversy. Critics, particularly in the pro-choice movement, pointed out, correctly, that the idea women are unlikely to become pregnant as a result of rape is a myth. In fact, the chance of sexual intercourse leading to pregnancy is the same whether the intercourse is the result of rape or consensual sex (Holmes et al. 1996). Moreover, they saw Akin’s distinction between legitimate and illegitimate rape claims as perpetuating the dangerous myth that false rape claims are common. Research shows that the majority of rapes are never reported, and only between two percent and eight percent of rape charges are false (Lonsway, Archambault, and Lisak 2009). On the other side, Akin supporters, particularly in the pro-life movement, stood by his candidacy and his specific comments about abortion. Missouri Right to Life, the state affiliation of the National Right to Life Committee (NRLC), repeatedly came to Akin’s defense, saying that his words were being “misinterpreted” and that the central point of Akin’s remarks was that all unborn children should be protected (Keller 2012). Former Arkansas governor and presidential candidate Mike Huckabee dismissed Akin’s words as the “verbal gaffe” of a “principled pro-life advocate” (Holt 2012).

The incident generated national political controversy, as politicians, commentators, pundits, editorial pages, journalists, bloggers, and scholars all debated the implications of Akin’s words and the larger debate over abortion. The discussion tied the abortion debate to a myriad different concerns. At issue was medical science, as people debated beliefs about fertility under different conditions. At issue was the problem of sexual assault, as people debated legal definitions and the boundaries of consent. At issue was partisanship, and the implications the incident might have for the fortunes of the two political parties and control of the US Senate. At issue were questions of morality, and whether there were such things as “good” and “bad” abortions. At issue was gender, as the question was raised of whether men and women had an equal right to make policy that impacted reproductive rights. These many debates caused Akin’s political fortunes to collapse, and he lost the election to Senator McCaskill, garnering only 39 percent of the vote in the same election that fellow Republican Mitt Romney received almost 54 percent of the Missouri vote for President.

A year later, a much different controversy centered on abortion. This time it revolved around the trial of Dr. Kermit Gosnell. Gosnell was a longtime advocate for abortion rights, even before the 1973 Supreme Court decisions legalized the procedure. He opened the Women’s Medical Clinic in 1979 to provide abortion and other services in the Philadelphia area, particularly to poor and minority women. Over time, however, his work evolved out of activism and medical practice into a multi-million-dollar business that conducted illegal abortions in unsanitary conditions, provided better care to white women than minority women, and on several occasions killed newborns after they had been delivered alive. The Pennsylvania Department of Health, the Board of Medicine, and the University of Pennsylvania’s Presbyterian Medical Center had all seen evidence over the years that something was wrong at Gosnell’s clinic, but none of them did much to stop Gosnell’s activities or alert authorities (Friedersdorf 2013).

The case once again made abortion the headline of national news and sparked rounds of controversy. Pro-life activists argued that Gosnell and the filthy conditions of his clinic were a window into the reality of abortion nationwide. David O’Steen, the executive director of the NRLC, argued that the case “helped more people realize what abortion is really about” (Associated Press 2013). The case, he said, “once again reminds us that the purpose of each abortion, no matter how it is performed, is to deliberately and brutally take at least one innocent human life” (National Right to Life Committee 2011). Gosnell and his clinic, pro-lifers told the public, were just like every other abortion provider. Pro-life organizations as well as conservative groups also criticized the lack of media coverage of Gosnell and his trial. Republican Congresswoman Marsha Blackburn, from Tennessee, accused the media of a “cover-up” (Viebeck 2013), and many conservative commentators, particularly on blogs and online social media, argued that journalists were deliberately staying away from the trial because it portrayed abortion in a negative light. Pro-choice organizations such as NARAL Pro-Choice America, Planned Parenthood, and the National Organization for Women (NOW) also condemned Dr. Gosnell and his crimes. But they argued that his clinic and approach were an aberration. Moreover, they blamed Gosnell’s crimes on the pro-life movement and the increased obstacles it placed in front of women seeking the procedure. “Kermit Gosnell is the result of anti-choice attacks on women,” said one message distributed by NARAL on social media (Howley 2013).

Like the national controversy generated the year before by Representative Akin’s comments on rape and abortion, the Gosnell murder trial generated debate that went far beyond the criminal fall of one physician. It raised some of the same issues, including issues of medical science, gender, partisanship, and whether there are moral distinctions to be drawn between “good” and “bad” abortions. But it raised additional concerns. At issue were inequality and racial prejudice, as Gosnell was widely reported to treat white women differently (and much better) than racial minorities. The role of the media and whether or not the majority of journalists and news outlets were taking sides in the abortion debate was also an issue. These were early echoes of what would become a national political obsession in the 2016 presidential race, with its swirl of fake news and accusations of media bias. Gosnell was convicted of first-degree murder in May 2013 after a trial lasting more than a month. He agreed to give up all appeals of his conviction and serve a life sentence in prison in exchange for not facing the death penalty.

These are just two, relatively minor, examples of the hundreds of times in recent years that the longstanding national debate over abortion has bubbled to the surface of public consciousness. Abortion has remained one of the most volatile and polarizing issues in the United States for more than four decades. Americans are more divided today than ever over abortion, and the debate colors the political, economic, and social dynamics of the country. In the first three months of 2017 alone, the New York Times’ opinion pages included sixty-eight separate pieces that mentioned the abortion issue – an average of a piece every two out of three days. Abortion formed the main focus of fifteen of these articles, more than one a week. Every year, both the pro-life and pro-choice movements spend tens of millions of dollars and millions more volunteer hours engaged in the controversy. Perhaps most importantly, the terms that have come to describe the two sides of the debate, “pro-choice” and “pro-life,” have become meaningful dimensions of cultural identity for many Americans.

As the Akin and Gosnell examples illustrate, however, controversy over abortion is always controversy about much more than just abortion. By debating abortion, people also debate questions of race, gender, sexuality, morality, partisanship, medical science, crime, and the media. Such issues are not raised alongside the abortion issue; they are a part of the abortion issue. Abortion has come to have layered meanings that touch on all these questions, as well as additional ones about religion, immigration, commercialization, and the role of government in the lives of everyday Americans.

The central argument of this book follows from such observations: the abortion debate is, and always has been, defined by the changing connections between the issue and other social and cultural divides in the American social fabric. From changing attitudes toward women, racial minorities, religion, and government, to technological and medical advancements, the development of the abortion controversy is embedded in the many other layers of conflict and change in society. The abortion debate is, in the end, a surprisingly empty vessel into which movements, politicians, and regular Americans have poured their anxieties and concerns. This book explores the (very long) history of the abortion debate in the United States. It shows how the pro-life and pro-choice movements were formed, how the issue has evolved, and the impact of the battle over abortion on politics and society. In doing so, it reveals the many ways abortion has been defined and redefined to meet the interests and concerns of different constituencies.

How This Book is Different

The books written about abortion over the last several decades would fill most library shelves many times over. But many of them are not about the abortion debate as much as they are a part of that debate. They are written from the perspective of one side or the other, often by people who are themselves activists in the pro-life or pro-choice movements. They often offer both information and insight about the controversy. But ultimately their goal is to persuade readers of either the rightness or wrongness of abortion, with the history, facts, and analyses of their volumes filtered by that larger goal. A classic example written by passionate pro-life activists is Why Not Love Them Both? (Willke and Willke 1997), a book that first appeared in the late 1960s and went through a series of editions and name changes over the more than thirty years it was in print. A more recent example by pro-choice activists is Targets of Hatred: Anti-Abortion Terrorism (Baird-Windle and Bader 2001). The perspectives of such books are evident in the titles themselves. Many others make their central goal less clear, but nonetheless focus primarily on mobilizing support for one side or the other. Unlike such books, this one does not take a side on abortion. It instead uses the language and tools of social science to explain the interplay of the pro-choice and pro-life movements in the development of the abortion debate.

A great deal of careful social science research avoids these kinds of biases. But scholars have blind spots of their own. A chief problem in the academic study of the abortion debate is that many social scientists treat “liberal” and “conservative” social movements differently. Scholars see them as caused by different forces and being subject to different dynamics. They are thus typically studied apart from one another, and far more attention is given to liberal movements than to conservative ones. In the case of the abortion debate, this means there are many excellent books on either the pro-choice movement or pro-life movement, but relatively few about both.

This book will question whether the pro-choice and pro-life movements fit so neatly into the categories of “liberal” and “conservative” and thus can be treated separately. The history of the abortion debate shows that the relationship of the two sides to American politics has varied over time. It also shows how movements on different sides of the political spectrum can be analyzed using the same conceptual tools. The pro-life and pro-choice movements have very different political goals and are composed of very different organizations, people, and sets of resources. But they are nonetheless subject to the same political, cultural, social, and organizational dynamics. This book addresses both sides of the abortion debate. It focuses on how both the pro-life and pro-choice movements, as well as the interaction between the two, have changed over time.

Abortion has been studied carefully by thousands of scholars, over many decades, and in fields ranging from embryology to philosophy, history to public policy, literature to economics, not to mention sociology, political science, and related fields. The amount of work available about abortion is, from the perspective of any given reader, essentially unlimited. Like any book, this one cannot possibly cover everything that is written. But it does touch on all these various areas, and citations in the text have been carefully chosen to steer the reader toward key texts and original research that will allow further exploration of abortion politics.

The Terms of the Abortion Debate

Before delving into any substantive or sustained discussion of the battle over abortion, some of the key terms must be defined. Both movements have made the terminology surrounding abortion part of the controversy itself, and some terms are frequently misunderstood as a result. I will refer to the people, groups, and organized efforts to reduce, restrict, or end legalized abortion procedures as the “pro-life movement,” and the equivalent efforts to protect or expand access to legalized abortion as the “pro-choice movement.” These names emerged in the 1970s, when the controversy over abortion became a widespread public issue. Prior to that time, the pro-choice movement was first called the abortion movement, and later the abortion rights movement (Staggenborg 1994: 188). The pro-life movement was known first as the right-to-life movement, and later the anti-abortion movement.

In using the terms pro-life and pro-choice, I make no claims that such labels accurately describe the movements or their goals. The pro-life movement rejects the idea that their opponents are providing “choices” and insist on calling them pro-abortion or even pro-death. The pro-choice movement rejects the idea that their opponents care about the “life” of women, referring to them instead as anti-abortion or sometimes anti-woman. Consistent with standards in social science research, particularly in research on social movements, I choose to let people decide for themselves what they should be called, rather than letting outsiders or opponents choose their name for them. As a result, I will use the same terms the movements use to refer to themselves: “pro-life” and “pro-choice.”

The term abortion itself is also subject to controversy and misunderstanding. One of the difficulties in understanding the abortion debate is the fact that what people mean by the term “abortion” has changed over time. What we refer to as abortion today was called an abortion in much of American history only if it happened late in a pregnancy, as the next chapter will recount in more detail. Even today, most discussions of abortion refer to the deliberate ending of a pregnancy. The term “abortion” itself, however, refers to any premature ending of a pregnancy, whether it is deliberate or not. Another term for a miscarriage is a “spontaneous abortion,” and approximately 15 percent of all pregnancies end this way in the United States (Jones and Kost 2007: 192). The abortion debate is not about such spontaneous abortions, however. When the term abortion is used here, it refers to a medical procedure in which a pregnancy is deliberately terminated through mechanical or pharmaceutical means. When we talk about abortion today, what we really mean is what medical professionals call “induced abortion.”

Abortion Statistics

With these terms in mind, a useful starting point for understanding the politics of abortion is to look at some basic facts about the procedure. The federal government does not collect centralized data regarding abortion. As a result, statistics need to be assembled by painstakingly surveying each individual abortion provider nationwide, as well as gathering and collating data from the health departments in each of the fifty states. These different sources of information vary in their quality; not all abortion providers respond to surveys, and each state health department collects different information and reports the results in different ways. The need to sift through and collate all this information means that abortion statistics are often delayed by several years. This monumental task of data collection in the United States has fallen largely on the Guttmacher Institute and its team of professional researchers. The Guttmacher Institute is avowedly pro-choice in its orientation, but the statistics it provides are widely respected as the most accurate available (even if its interpretations and policy recommendations are contested).

According to the Guttmacher Institute, there were an estimated 926,200 abortions in the United States in 2014 (Jones and Jerman 2017). This translates into a rate of 14.6 abortions per 1,000 women aged 15 to 44. The abortion rate has been declining for decades in the US. The estimated rate was 16.3 in 1973, the year the US Supreme Court legalized abortion nationwide. The frequency of abortion increased dramatically over the next decade, peaking at 29.3 in 1981 (see Figure 1.1) (Jones and Kooistra 2011). It has declined steadily since that time, so that the 2014 abortion rate was the lowest ever recorded. Nonetheless, these rates mean that a large proportion of American women have direct experience with abortion; somewhere between 22 percent and 30 percent of women will have an abortion procedure at some point in their lifetime (Cowan et al. 2016; Jones and Kavanaugh 2011). More globally, the abortion rate is even more difficult to estimate. One of the best estimates puts the rate at 35 per 1,000 women aged 15 to 44 – or more than double that of the United States (Sedgh et al. 2016); though at least one pro-life organization argues that this global rate is greatly exaggerated by using estimates of abortions not included in official government statistics (Jacobson and Johnston 2017).

f1.1.tif — **Figure 1.1**Abortion Rate in the United States, 1973–2014. Source: created with data from Jones and Kooistra (2011), Jones and Jerman (2017)

A significant amount of debate surrounding abortion focuses on when and how abortions are performed. Most abortions are performed early in a pregnancy, well over half (66%) in the first eight weeks and the vast majority (92%) within the first thirteen weeks. Only one percent of abortions are performed on women who have been pregnant for twenty weeks (five months) or more (Jatlaoui et al. 2016). Non-surgical medication abortions, performed by taking pills, make up an increasing share of the total number of abortions in the United States. The US Food and Drug Administration allows medication abortions in the first ten weeks of pregnancy. In 2014, 29 percent of abortions were conducted this way (Jones and Jerman 2017).

Abortion is relatively safe compared to other medical procedures. Between 1998 and 2010, there were 0.7 deaths per 100,000 abortions, though this rate varies greatly according to the point in the pregnancy when the abortion is performed. There were only 0.3 deaths per 100,000 abortions performed at eight weeks or less, but 6.7 per 100,000 for those performed at eighteen weeks or more (Zane et al. 2015). As points of comparison, one study of appendectomies found 1,800 deaths per 100,000 procedures (Margenthaler et al. 2003); a (Swedish) study of tonsillectomies found a death rate of approximately two per 100,000 procedures (Østvoll et al. 2015).

Who receives abortion services is also often part of the discussions surrounding the issue. A common stereotype of those who seek an abortion is the teenaged girl who accidentally gets pregnant. Such cases do exist, but the majority of women (60%) seeking abortion are in their twenties, while less than four percent are seventeen years old or younger. The majority (59%) also have at least one child already when they receive their abortion. Approximately 14 percent are married and another 31 percent are living with a partner. Almost half (49%) are living below the federal poverty line (Jerman, Jones, and Onada 2016). These numbers show some broad patterns, but they also suggest there really is no “typical” abortion patient. Abortions are performed on women in a wide range of ages, relationships, and social and economic circumstances.

Litanies of facts sometimes play an important role in the abortion debate. At other times, they are largely forgotten. Like so many issues that become subject to public moralizing and debate, the controversy is less over the facts and more over what those facts mean. This book explores those meanings, both across time and across different groups of individuals. It focuses on the two social movements that have been central players in the abortion debate, but it also pays close attention to the cultural and political backdrop against which the abortion debate plays out.

Looking Ahead

The next two chapters focus on the pro-life and pro-choice movements themselves. Chapter 2 tells the early history of the abortion debate, from the beginning of the nineteenth century to the 1973 Supreme Court decisions that legalized abortion throughout the country. This historical context is important, because the social, economic, and legal forces that shaped discussions of abortion during the nineteenth and twentieth centuries continue to have a profound impact on the abortion debate today.

looks at how the two movements have developed and interacted since 1973. The modern pro-life movement’s roots in the Catholic Church colored the way it approached the issue until at least the late 1980s. The modern pro-choice movement’s roots in the larger women’s movement continue to be critical to its fortunes today. Both movements, however, are more diverse and heterogenous than is commonly recognized. explores the diversity of each movement. On the pro-life side, the movement consists of several different mutually supportive but largely distinct wings, including one devoted to legal challenges and political pressure, one devoted to street protest, and one to outreach among individual pregnant women. On the pro-choice side, the movement consists of a political and legal wing that mirrors its counterpart in the pro-life movement. There is also a wing devoted to making abortion services available to women by supporting clinics that provide abortion and the patients who seek them.

With the origins and dynamics of the two movements established, the next three chapters explore the politics of the abortion issue. Chapter 4 sets the stage for this discussion by introducing public attitudes that surround abortion. It begins with an overview of public opinion on the issue drawn from a variety of different surveys. It shows how virtually all Americans identify themselves as either pro-life or pro-choice, yet relatively few support the stated positions of either the pro-life or pro-choice movements. Instead, most of the general public hold conflicted views of abortion. They find abortion troubling, favor many restrictions on the procedure, but are wary or opposed to an outright ban. The chapter also documents the relative stability of abortion attitudes over time. The overall percentage of Americans who support abortion under various circumstances hasn’t changed very much for almost two generations, despite the dramatic change in public attitudes toward a variety of other social issues over the same period.

Chapter 5 examines how abortion does and does not affect American politics. Many are surprised to learn that abortion is by and large not an issue over which most voters decide directly which way to vote. Instead, abortion is politically important because it affects cultural – and hence political – identities. The labels “pro-life” and “pro-choice” refer less today to a person’s specific views about the abortion procedure and more to identifying different “types” of people. Abortion as a marker of cultural and political identity has come at a time when the issue has become closely tied to the political party system. Republicans are pro-life and Democrats are pro-choice. The abortion debate has been a key factor in making both parties more ideological over the last several decades.

The discussion of the abortion debate through Chapter 5 focuses almost exclusively on the United States. Chapter 6 expands this view by comparing the American experience with the abortion issue elsewhere in the world. Controversy has surrounded abortion in most industrialized democracies. But it has been stronger in the United States, lasted longer, and reached into many more aspects of the country’s political and social culture than elsewhere. This chapter explains the institutional, ideological, and historical reasons for this difference. The United States is different because of differences in its political system, and its longstanding and robust history of moral politics. And abortion has remained more controversial because its meaning has adapted to the changing anxieties and concerns of the public in ways that did not occur elsewhere.

Chapter 7 integrates the various parts of the abortion debate discussed in the previous chapters. The emphasis is on the interaction between the abortion controversy and other key divisions in society – particularly race, class, and partisanship, as well as the dynamics of other moral issues, including birth control, gay marriage, and capital punishment. In doing so, it underscores the nuances and changing meaning of abortion both over time and across different groups. These dynamic interactions are evaluated with an eye toward the future of the abortion debate. Understanding abortion politics is not simple. But understanding this complex issue provides key insights into the nature of how individual beliefs, social structures, and social movement outcomes are bound together.

Series Title

Social Movements series

Copyright page

Dedication page

Acknowledgments

1
Introduction

How This Book is Different

The Terms of the Abortion Debate

Abortion Statistics

Looking Ahead