Choice and Coercion: Birth Control, Sterilization, and Abortion in Public Health and Welfare

By Fox, Rebekah | Nursing History Review, January 1, 2007 | Go to article overview

Choice and Coercion: Birth Control, Sterilization, and Abortion in Public Health and Welfare


Fox, Rebekah, Nursing History Review


Choice and Coercion: Birth Control, Sterilization, and Abortion in Public Health and Welfare By Johanna Schoen (Chapel Hill: University of North Carolina Press, 2005) (352 pages; $59.95 cloth, $19.95 paper)

In Choice and Coercion, Johanna Schoen highlights the double-edged nature of reproductive technologies: "they could extend reproductive control to women, or they could be used to control women's reproduction" (p. 3). Although Schoen's focus is on the historical development of the role of sterilization, abortion, and other reproductive technologies in public health and welfare policies, her words capture the controversy facing policy makers and citizens in the United States today. Indeed, the book's publication is apdy timed given the recent vacancies on the U.S. Supreme Court, which could affect women's reproductive rights.

Those seeking a better understanding of the current controversy would do well by reading Choice and Coercion because it is a thoroughly researched and well-written contribution to the study of reproductive health. In analyzing birth control, sterilization, and abortion policy making in the twentieth century, the author draws from an impressive collection of manuscripts, interviews, newspapers, periodicals, books, articles, and dissertations. Most important, Schoen reviewed 8,000 sterilization petitions dating from 1934 to 1966 and eventually obtained access to the minutes from meetings of the Eugenics Board that enabled her to tell the stories of women, families, physicians, and social workers involved wirh family planning during this time. Her work helps show how birth control, sterilization, and abortion could be either liberating or controlling, according to society's beliefs about race and gender at the time. She specifically focuses on North Carolina's reproductive health care system during the early to mid-twentieth century, not because it is an anomaly but because it resembled policy creation and implementation in other places in the United States and abroad. In her comparison of policies in North Carolina to situations in Puerto Rico and India, Schoen takes her study to the international level. She writes, "Economic undeidevelopment, poverty, perceived overpopulation, and a demographic orherness" made portions of the United States, Puerto Rico, and India all "ripe for the scientific and sexual experiments of philanthropy" (p. 8).

To examine this experimentation and its social, political, and economic effects, the author divides the book into four chaptets, each of which builds on the tension between women's control over their own reproduction and the power of health professionals and policy makers to control population. The book closes with an eye-opening epilogue containing a critique of current sterilization reparation measures.

The first chapter provides an historical account of birth control services in North Carolina, South Carolina, and Tennessee for poor white and black populations, emphasizing the "lack of a coherent delivery system" and the resulting "patchwork of services of uneven quality" (p. 24). Many rural women had little of no access to birth control services but were frequendy used in contraceptive field trials and experiments. A central character in the chapter is Nina Hillard, a birth control nurse paid by philanthropist Clarence Gamble. Hillard often found herself in conflict with the rigid research protocols as she empathized with her clients' desires for one form of contraception over another. This chapter concludes by introducing the irony in the government's preference, after Woild War II, for family planning and population control to lower health care costs and welfare dependency, while limiting women's access to the method.

In Chapter 2, Schoen examines the politics of sterilization through the creative use of a eugenics poem written by Boston philanthropist and birth control activist, Clarence Gamble, in the mid-1940s. The poem not only echoes popular sentiment of the time by celebtating eugenics, but it also provides a rich starting point to discuss the different aspects of sterilization. …

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