I come to the issue of abortion and abortion restrictions from a different angle and with a different focus than those used by Carol Sanger in her wonderful new book, About Abortion: Terminating Pregnancy in Twenty-First Century America. In my scholarship, I’ve been interested in how the regulation of abortion has been a mechanism by which the state can regulate race and class. Specifically, I’ve been interested in the role that race and class have played in women’s ability to access abortion (as well as contraception and sterilization). I’ve also been interested in the role that race and class have played in women’s ability to choose to eschew abortion, contraception, and sterilization and to become mothers and parent their children with dignity.
If you take a look at the nation’s history, you will find that many restrictions on abortion, contraception, and sterilization are directly related to the state’s interest in forcing affluent white women to have babies. This interest was a product of racist fears triggered by a decreasing percentage of white children born to native-born white people in the United States. So, abortion, contraception, and sterilization restrictions were a means for regulating race and class insofar as they were a way to control the bodies and the fertility of white women with class privilege: the state controlled their bodies by forcing them to be fertile.
However, at the same time that class-privileged white women were being encouraged to have children, poor women and nonwhite women were being actively discouraged from having children. While white women were fighting for access to abortion, contraception, and sterilization, poor women and nonwhite women were the victims of coercive sterilization. A couple of examples from history might be instructive:
• According to a survey conducted in 1965, a third of Puerto Rican women living on the island had been sterilized. Sterilization was so common that people referred to it as “la operación”– a generic “operation.”
• In the 1970s, the Indian Health Service sterilized scores of indigenous women without their consent. The case of Norma Jean Serena, an indigenous woman, is illuminating: She had signed a “Statement of Need for Therapeutic Sterilization,” which reads in relevant part: “We find from observation and examination of Norma Serena that she is suffering from the following ailment of condition: …‘socio-economic reasons’… and that another pregnancy in our opinion, would be inadvisable. Therefore, we are of the opinion that it is medically necessary to perform the sterilization.” Serena had been told that her sterilization was medically indicated. She discovered later that she actually had been sterilized simply because she was poor.
• Poor black women have been coercively sterilized throughout this country’s history. Forced sterilizations were so common in the south that they were called “Mississippi appendectomies.” One of the most famous cases of sterilization abuse occurred in 1973 and involved the Relf sisters. They were 12 and 14 years old when an Alabama physician deemed them mentally incompetent and subsequently sterilized them. Their mother couldn’t read or write. Indeed, she had signed an “X” on the consent forms.
So, with respect to poor women and nonwhite women, the failure to restrict abortion, contraception, and sterilization was a means for regulating race and class insofar as it was a mechanism by which the state could control their bodies and their fertility: the state controlled their bodies by forcing them to be infertile.
In About Abortion, Sanger does a deep dive into modern abortion regulations. She notes that “[m]uch of the regulation takes as its starting point that pregnant women and girls do not exactly understand what they are doing when they decide to end a pregnancy. That is why they must be told when human life starts, that a fetus is a child, that it has a heartbeat and maybe fingernails, and that adoption would work to make everyone happy” (23). The types of regulations to which Sanger is referring here are involved in the business of moral suasion. They try to make arguments about the moral status of the fetus: they try to convince women to carry their pregnancies to term by telling them that they are presently carrying a morally consequential entity—a baby.
But, abortion regulations with respect to the populations in which I have been interested—poor women, who are disproportionately of color—do not look like this. The regulations that have been aimed at populations without class (and race) privilege are much more in the business of coercion. I’m referring to the Hyde Amendment here. The Hyde Amendment is a federal legislative provision that prohibits the use of federal Medicaid funds for even medically necessary, therapeutic abortions. While the Hyde Amendment currently allows indigent women to use Medicaid funds to terminate pregnancies that endanger their lives or are products of rape or incest, it denies funds to terminate pregnancies that endanger women’s health. Thus, the Hyde Amendment leaves poor women to be maimed by their pregnancies. Again, Hyde is not in the business of moral suasion. It does not attempt to persuade women to carry their pregnancies to term by arguing that the fetus is like a baby—with a heartbeat, fingernails, the ability to feel pain, etc. Hyde coerces indigent women to carry their pregnancies to term by leaving them—indigent women—to scrape together the $300 to $3,000+ for their abortion procedures.
In the final chapter of the book, Sanger muses on how we can begin to normalize abortion. She argues that the first step in this project of normalization is that women who have had abortions need to talk about their abortions. Sanger’s discussion might prompt us to think about how Hyde works against any project of normalization. That is, Hyde works to abnormalize abortion. Or, we might say that Hyde normalizes abortion as an abnormal procedure. Hyde creates a narrative that suggests that it is normal for us to think of abortion as something that is appropriately excluded from health insurance plans.
Let’s be clear: Medicaid—which is health insurance—does not cover the costs of even therapeutic abortions. This is both materially and discursively powerful. Hyde is materially powerful inasmuch as it powerfully impacts the material lives of indigent women: it frequently coerces poor women into motherhood. And Hyde is discursively powerful insofar as it creates and legitimates discourses that describe abortion as “not healthcare.” If abortion is “not healthcare,” then there is nothing unusual about its exclusion from health insurance plans that cover the cost of healthcare. Compare this landscape with an alternative landscape wherein abortion is understood as a normal medical procedure: as a normal medical procedure, its exclusion from health insurance plans would be abnormal. The discursive effect of the Hyde Amendment is to impede the development of this alternative landscape.
I agree with Sanger that we need to normalize abortion. That is why I believe that in addition to talking about abortion, we might also pay attention to how institutions—like our public health insurance program—abnormalize abortion.