Category: Symposium (About Abortion)

Book Symposium on Carol Sanger’s About Abortion


Carol Sanger Replies to Linda McClain: Man Decides Against Fatherhood!!

I am hugely grateful to Linda McClain not only for taking on but for expanding the research program suggested in my “innovative” (Linda’s kind words) chapter Fathers and Fetuses: What Would Men Do?   The fact that it is innovative (and it is!) takes us to one problem about how abortion gets talked about: men fall out of the picture, except when, like Mike Pence and his accompanying swarm of other white men (plus now Charmaine Yoest) they are setting abortion policy.

This chapter attempts to put men into the picture not as policy makers but as players in the actual world of reproductive decision making.  Although McClain gets exactly what I am with this approach to show that decisions about becoming a parent may be more generic than gendered, she puts the question of whether the attempt will “make a theoretical or practice difference?”  Ouch!  More specifically, McClain asks whether knowing about “men’s moral reasoning” will   “make women’s moral reasoning seem more ‘moral’ or ‘responsible’?”

I think the answer is yes, but I want to clarify two points.  The first concerns the characterization of the reasons men gave in the frozen embryo cases I looked at as “moral reasoning.”  There was almost no discussion at all of morality in the embryo or the surrogacy cases.  Consider the case of the father who rejected a disabled newborn born to a surrogate mother on the ground that no child of his could have such defects. Morality didn’t come into the calculus, at least in any overt or articulated way.  Other men didn’t want their embryos implanted because they didn’t like the ex, they had enough children, or they were single again (woo-hoo!) and didn’t want to be burdened by fatherhood.  They didn’t say a thing about ending embryonic or fetal life, or about that having been an aspect of what concerned them.  It was all much more straightforward and practical and no nonsense.  In this regard, their explanations contrasted to the thought processes of women, where at least some today confront the fact of what an abortion does (though most proceed anyway). Yet the stories of women today differ from those of women who chose abortion before it was legal and for whom being able to terminate their pregnancy was an unqualified relief.

But assuming that, for example, “having enough children” includes “taking care of them properly.”  Then we do have a moral calculus and so to McClain’s question: “Is the moral calculus in a man’s decision about when to become a parent likely to change the mind of someone who believes abortion decisions are primarily made for reasons of ‘convenience’?”  McClain is skeptical, especially when it comes to legislators. Avoiding responsibility is not enough to excuse taking the life that anti-abortion activists vest in all forms of prenatal life, and this is likely to be true, says McClain whether the shirker is a man or a women.  Indeed, in recent weeks we have gotten a peek at how men too are on occasion regarded as selfish or at least disenfranchised from adult responsibility for not having children.  During the French elections, the accusation was hurled at Emmanuel Macron by his opponent Marine Le Pen: “He talks to us about the future, but he doesn’t have children.”  That argument (nor any other) carried the day, though one wonders what would have happened had the shoe been on the other foot. Even Margaret Thatcher knew she needed to have children in order to improve her Conservative street cred.  (Lucky for her she had twins and got it over with at once.)

Let us return to McClain’s suggestion that knowing the parallels between men and women’s reasons isn’t going to move the needle toward a greater understanding of women. I therefore agree with McClain that this interesting information may not (yet) be a persuasive pitch to pro-life legislators.  This is because its present value may be for women alone. And what is the value to women?  It is to suggest to them that they are not wicked, because men make the same decision and no one calls them selfish or immoral.  It is to see that the decision was not whimsical but rational—just like the decision of some men on the same matter—despite the tinge of disrepute that hovers over the woman’s choice.

But not much hovers over men.  After all, if men were regarded as badly as aborting women, then it would be fitting for pro-life activists to protest outside vasectomy clinics, or for legislators to enact a waiting period, or require that video of life-begetting sperm swimming around be offered at the clinic before consent is valid, or to produce their very own sperm, as with mandatory ultrasound.  But we don’t require any of this, and not just because sperm are different in kind from embryos.   It is because male reproductive behavior is understood differently than women’s.  Men were never assigned the “paramount destiny and mission of … fulfill[ing] the noble and benign offices of wife and mother, that Justice Bradley announced in his concurrence in Bradley v. Illinois. And those familiar with the oft quoted line know who made this assignment: “This is the law of the Creator.”

I am trying to show women that men have similar concerns when it comes to deciding about parenthood, even discounting for the fact that in calculating their preference, men do not have to weigh in the pregnancy and child birth that precede childbirth nor the years of childcare that follow it.  It is the dense underbrush of maternalistic ideology that makes it hard to see or accept the equivalency or to push it publicly.  Nevertheless, as an internal readjustment of what women themselves experience—that their decision is “wrong but the right thing to do”—might drop the wrong all together. There may be solace in seeing a gender-free universality of what some men and some women regard as necessary for flourishing on their own terms.

I am deeply grateful to Linda for pushing me on all this; I am not a theorist of the family as is Linda.  In responding to her post, I went back and read nearly two decades of her work on abortion.  I will mention only one piece, a chapter called Equality, Oppression, and Abortion: Women Who Oppose Abortion Rights in the Name of Feminism that took on gender as a problem among women themselves.  (Editors of Concurring Opinions! Please invite me to be a commentator when Linda puts these pieces together into her own book on abortion.)

The chapter is from an anthology called Feminist Nightmares: Women At Odds. But like Linda, I am tired of abortion being a nightmare for women, instead of a decision, however morally imbued it may be for many, that they are capable of making.  As a way of moving things forward, Linda has suggested research avenues that might clarify the role of gender in the public politics of abortion and in its private practices as well.  A fruitful place might be at the decision making process or consultations between partners confronted by an unwanted pregnancy, or at the advice that trusted men friends give to women in contrast to the advice by trusted women friends.  (To date, scholarly work has focused on the accounts of men whose ex-girlfriends had an abortion which gives us only an after glimpse; there are also healing and forgiveness online sites for men suffering from their complicity or loss regarding a pregnancy that was terminated.)

Each of us brings our own skill set (that was for male readers) to the question of abortion.  What this Symposium has shown me was that our distinctive interests and approaches results not only in an important division of analytical labor but in a generous and deeply intellectual exchange that will advance our collective interest in this topic.  As Dave Pozen said at the start, what Sanger is after is “less heat and more light.” I want to thank Linda McClain and the other contributors for providing a lot more light. I am grateful.


Carol Sanger Replies to Leslie Griffin: Doctrinal Recalcitrance and Lay Practices

I am grateful to Leslie Griffin for discussing so candidly the Roman Catholic Church in the culture of abortion in the United States. Griffin explains how many Catholic Americans have learned not to talk about abortion, and how Church hierarchy has influenced Catholic politicians to legislate against it.  (It was not for nothing that the constitutional challenge to contraception bans for married couples arose in Connecticut.)  Each presidential cycle, bishops and priests in dioceses around the U.S. announce that Roman Catholic candidates who support legal abortion—Biden, Kaine, Kerry—should be barred from communion, and some have extended the ban to voters who would vote for such candidates.  Such orders from on high show the tremendous power of the Roman Catholic hierarchy over officials, would-be officials, and some parishioners.  (It is not only theology that does this work but non-canonical texts as well: every time I look for a copy of Naomi Wolf’s 1995 New Republic essay Our Bodies, Our Souls (feminists losing their souls through “Chardonnay abortions”), it conveniently pops up on the Priests for Life website.)

Yet, says Griffin, this outsized influence has left much of the laity out in the cold.  She points out that the distinction between the beliefs and practices of rank-and-file believers versus those in religious and economic hierarchies is especially crucial now.  Hobby-Lobby taught us that closely-held companies can have a religion. Faith-based exceptions are now the latest legislative tactic to end run the exercise of protected right of choosing abortion (or getting a marriage license, for that matter.)  And just a few days ago, President Trump expanded that holding through his new executive order, “Promoting Free Speech and Religious Liberty.”  This means that what Griffin calls the “almost-unreflective defense of the hierarchy over the laity” has now become federal policy.

I want to respond to three aspects of Griffin’s post that directly concern religion.  The first is to provide three more data points as to the divergence between Catholic abortion doctrine and Catholic abortion practices.  The Guttmacher Institute’s latest figures (2014) show that 24% of aborting women identified themselves as Catholic.  Guttmacher further reports that “by their early 20s, some 79% of never-married women—and 89% of never-married Catholic women—have had sex.”  Finally,  American women of reproductive age (15–44)—“including 99% of all sexually experienced women and 98% of those who identify themselves as Catholic—have used a method of contraception other than natural family planning at some point.”  This suggests that whatever the moral burden they may carry, Catholic women in the U.S. have the same sexual practices and use the same reproductive strategies as the rest of the population.

The doctrinal rigidity (or integrity, depending on your point of view) of Roman Catholic officials has its costs.  Take an example from Germany, where following reunification, all women seeking an abortion in Germany are required to receive counseling from centers of their choice as a condition of consent.  Roman Catholic women often sought counseling at centers run directly by the Catholic Church or by church-related charities.  In 1995, however, Pope John Paul II ordered the Catholic Bishops to withdraw from abortion counseling services on the ground that even counseling against abortion made the Church complicit in the practice; counselors had no veto power and once counseled, women could do whatever they wanted.  Several German bishops protested “in order to be able by goal directed counseling to save many unborn babies from being killed and to support women in difficult living situations with all the means available,” but in the end, they agreed to “bow to Rome.”

Second, I note that the Roman Catholic is no longer the sole religious entity who now vigorously participates in the politics of abortion.  It is now joined by Evangelical Christian leadership.  I have not studied the differences between the doctrines of the two faiths, nor how they work together, nor how they solidified their political roles.  In this regard, I found Robert Wuthnow’s Rough Country: How Texas Became America’s Most Powerful Bible Belt State very powerful but I would love scholars like Leslie Griffin to explore the issues she raises across America’s religions; there were a heck of a lot of religious types standing behind the President when he signed that Executive Order in the Rose Garden, each one pleased they would be able to throw more weight around in the hierarchy/hoi polloi split.

Finally, a word about the alleged optimism I express in About Abortion, for example, reminding us that “both abortion and religious freedom wind up being [near intractable] discussions about morality,” Griffin suggests my call for more talk by women about abortion is a “conversation even more difficult than Sanger imagines.”  She also observes a “very optimistic tone in regard to the decision in Whole Woman’s Health, stating that maybe “in a country that is full of pro-lifers on the Court and off, any Court victory for abortion rights is a big win.”  While this is not Griffin’s main point, she offers the occasion to address it and so I shall, in part because Leslie is not the only one who has noted a perhaps too cheerful disposition. I have taken it on the chin for a phrase in the final paragraph of About Abortion—“as abortion becomes less stigmatized, as it will in time ….”  Says who? asked one audience member. Aren’t you awfully cheerful about the state of abortion law?

I acknowledge that because I want things to be better for women exercising the abortion right.  Thus when Justice Gorsuch is asked about his opinion of Roe v. Wade and he replies that he accepts the case as the “law of the land,” I hope that he will, like the majority in Casey, regard the principle of stare decisis as determinative.  (I say “hope” rather than “would bet the house on” because I know that prior decisions are sometimes overruled;  the dissenters in Casey would have no doctrinal trouble overruling Roe.)  I over-invest in any thin reed that blows toward societal progress on the matter?  After reading her critique, which underscores that practicing Catholics have nothing less than their souls officially at stake, I accept—but do not abandon—the difficulty of my proposal.

To be clear, I am not a Pollyanna by nature; I am, for example, extremely pessimistic about the state of the planet.  But with regard to how abortion is practiced and regulated,  there are signs both of resistance and of progress.  Whole Women’s Health and its requirement of evidence-based proofs that something is good for women’s health is a huge step in righting the terrible path wrought by deference to legislative purpose as stated in the statute itself.  Tennessee and other states have voluntarily withdrawn regulations modeled on Texas’s following the decision in Whole Women’s Health.

The laity now has expanded sources for understanding church doctrine beyond parish priests.  The organization Catholics for Choice now offers on-line lectures called “The Secret History of Sex, Choice and Catholics” with theologians and other scholars explaining official doctrine over time.

My point is not to dispute doctrine as it rigidified under Cardinal Ratzinger (later Pope Benedict) in his role as Prefect of the Congregation for the Doctrine of the Faith but simply to emphasize that it has not always been thus.  Grievous sin has been a mutable category.  Recall that even Pope Paul VI authorized Belgian nuns working in the then Belgian Congo to use birth control pills in the face of rape in the 1960s.  I think the laity might find comfort—perhaps fortitude—in these shifts and exceptions.  Morals, like official Roman Catholic doctrine, are fluid.  People are persuaded by argumentation that something—same-sex relationships, for example—are acceptable even though just one generation ago were the very essence of immorality, or like smoking—once regarded as pleasurable and even sensuous; think of the cinematic lighting of another’s cigarette—is now shameful and its practitioners are left to the freezing sidewalk.

My last example comes from Rome. In 2016 Pope Francis urged priests to absolve parishioners who have committed the sin of abortion on the ground that “there is no sin that God’s mercy cannot reach and wipe away when it finds a repentant heart….” In response, some pro-choice advocates have said, “Thank you so very much, but absolution requires an acknowledgment of wrong doing, and women who terminate unwanted pregnancies are not doing anything wrong.”  My personal view is that Francis’s position is better for Catholic women who terminate unwanted pregnancies that the prior regime of official condemnation or private withdrawal from a religious community. As Griffin says, progress is going to be hard but it is not impossible.


Carol Sanger Replies to David Cohen: The Risks Providers Take for Us

About Abortion focused on women—as patients, as decision makers, as the gatekeepers of human existence, to borrow from Rayna Rapp’s arresting phrase. Yet as David Cohen points out, everything I wrote about women in About Abortion has a parallel, often more aggressive application to abortion doctors (or “providers” as we call them to lower the rhetorical heat by staying as far away from “abortionists” as possible). Cohen’s post prompted me to think harder at how crime and punishment work for abortion medical professionals when compared with their patients.

Stand outside any number of abortion clinics across the United States and you will see a variety of “Don’t Kill Your Baby” signs, supposedly aimed at getting women not to commit murder but to go home and presumably adjust to the motherhood they didn’t want.  But the real murderers, by anti-abortion lights, are not the women but the doctors and nurses who make abortions actually happen.  We see this in pre-Roe criminal abortion laws, the doctor was charged criminally but not the woman.  But why wasn’t she charged? One might think that as with any contract killing, she who commissions the killing is just as guilty as he who pulls the trigger.   This is how it works normally under our criminal justice system.

There are two kinds of reasons why doctors and not patients are prosecuted under criminal abortion laws, which, by the way, are just itching to come back under Vice President Pence and his state counterparts.   The first reason is that abortion providers are thought to be more culpable than pregnant women, who for the most part, have a single abortion.  Doctors do it over and over again. Thus we get phrases like “abortion mills.” But murder is murder. You might get a longer sentence for being a serial murderer, as abortion providers would be considered, I suppose, but you don’t get absolved because you only paid for the hitman to do it.

This leads to the second set of reasons we leave women out.  The traditional reason is that women do not consent freely to abortion: they are under the power of two categories of opportunistic men who lead them to abortion. The first are doctors for the purpose of getting rich; the second are impregnating men for the purpose of keeping the benefits of sex with women by avoiding the liabilities of fatherhood.   On these accounts, women are not perpetrators but victims themselves.  Due to the shortfalls in their moral and intellectual reasoning, women are but dupes.

But women understand very well what they are doing when they consent to abortion: they want to terminate an unwanted pregnancy.  I would like then, to modestly propose that the criminal law should recognize this agency (should Roe be overturned) and follow it where it leads, which under criminal abortion statutes is to arrest, prosecution, and conviction.   There is something coherent about this; just as it would be coherent and worthy of respect if pro-life advocates also opposed the death penalty.  I suggest that this proposal surfaces what may be a  more telling reason why women will continue go unprosecuted under a criminal abortion regime: no one wants to see their mom, neighbor, cousin, librarian or babysitter taken down to the hoosegow. Keeping aborting women out of jail is a way of maintaining abortion as the open secret that it is.

And what about the darling of anti-abortion supporters, the convicted doctor, Kermit Gosnell, “a sociopath who also happened to be a doctor,” in Cohen’s words, who killed a woman patient and several born babies in his shoddy offices.  Gosnell was rightly convicted of murder but the story didn’t end there.  He became the demon poster child in support of even more stringent laws regulating abortion providers.  He was regarded less as an exception to abortion practice than as proof of the criminal essence of all of it.  Cohen introduces Gosnell to show in part how naturally (and opportunistically)  pro-life legislators can deploy true crime to tarnish the valiant but beleaguered practitioners who make it possible for pregnant women to exercise their right to choose.

One final point about the narrative of abortion’s lurking criminality.  The argument that a procedure that is a crime can’t at the same time be medical treatment operates as an intensifier to Khiara Bridges’s demonstration of how abortion is also lifted out of the medical realm through its exclusion from Medicaid under the Hyde Amendment.   Cohen and Bridges show that pro-life forces come at abortion from sorts of all angles to make sure it is not normalized as medical treatment.

That was my take on crime, but a quick summary of punishment.  In About Abortion, I explain how legislators up against Roe’s essential holding that abortion cannot be criminalized have legislated as close that line as possible. In this way, complying with the ever inventive variety of abortion regulations—burying fetal remains,  having to hole up in a motel while the waiting period ticks by,  rejecting (or not) the invitation to look at the image of one’s unborn child– operates as a non-criminal form of punishment  for pregnant women.   Cohen turns our attention to the non-criminal punishments for abortion providers.   In Living in the Crosshairs, he and co-author Krysten Connon bring us into the daily world  of doctors and other healthcare providers who are brave and resilient (mostly) and resourceful,  faced as they are by dogged opposition.   Abortion providers are targeted, harassed, and reviled as a matter of politics, law, and within their own profession to boot.   Making them live within the crosshairs is punishment as well as harassment, and an extremely difficult way to proceed with one’s profession day after day after day.  Thanks then to Cohen for helping us understand this.  And to Amelia Bonow  and Gloria Steinem who by expressing gratitude to their abortion providers remind us where additional thanks is due.


Carol Sanger Replies to Rachel Rebouche: Images, Imagination and Ideology

In focusing on Chapter 6, You Had Body, You Died, Rachel Rebouche goes directly to the emotional complexities that derive from the corporality of prenatal life.  The title comes from a poem about abortion called The Mother by Gwendolyn Brooks.  Its last two lines read: Oh, what shall I say, how is the truth to be said? /You were born, you had body, you died.   Chapter 6 considers how seeing a fetal body—or even an image suggesting a body—influences how the entity is imagined and how it is responded to as a dead body.

Of course, what you think you see—the size of an embryo on a monitor, for example—may not accurately capture the entity itself. Rebouche, just back from a photo exhibit in Stockholm, points out that the iconic photos by Lennart Nilsson of Life in the Womb were, with one exception, miscarried or aborted fetal bodies, even if they looked magical and alive.  Yet historically, the benefits of ultrasound were not ideological in nature, but rather, they were aimed at improving public health by detecting early fetal abnormalities for the purpose of a possible abortion.  Thus as Rebouche puts it, “’normalizing abortion’” has always occurred in the area of prenatal diagnosis.

I want to develop Rebouche’s point in the context of the Zika virus.  Here imaging the brain is crucial in evaluating the calcification of the fetal brain so that a diagnosis of microcephaly can be made.  Yet an accurate reading cannot be taken until relatively late in a pregnancy.  In a 2015 case study, ultrasounds taken at 14 and 20 weeks of gestation showed normal fetal growth and anatomy. Only at 29 weeks did the first signs of fetal anomalies show up, and it took the 32 week ultrasound to finally confirm “a head circumference below the second percentile for gestation (microcephaly) [and] numerous calcifications in various parts of the brain.”  The problem is that 17 states have now banned abortions after 20 weeks, most often on the supposition that that is the marker for fetal pain.  This means that women with wanted pregnancies might have to roll the dice before 20 weeks, if they know they would terminate the pregnancy if faced with a diagnosis of microcephaly.  As I’ve said before, the age of Zika is not the time – it is never the time – to play politics with women’s health or their rights.   Perhaps we see the issue more clearly when we are dealing with pregnancies made unwanted on account of environmental threats, rather than in individual cases where it is easy to tag women as careless, selfish, and cruel.

Finally, I turn to Rebouche’s excellent point regarding my call to end abortion secrecy when that call is applied to pregnant teenagers.  She rightfully notes that bypass hearings are all about minors talking, and look how well that turned out! I myself make the case in About Abortion that minors’ testimony at bypass hearings sometimes resembles a compelled form of gossip about oneself.  I certainly agree that testimony is a very different thing from the form of chosen disclosure I have in mind with regard to “abortion talk.”  But Rebouche’s insistence on recognizing minors’ agency is key to fixing the bypass process, as it now exists in nearly 40 states.  As William Saletan made clear in Bearing Right: How Conservatives Won the Abortion War, restrictions on teenage abortion are the easiest thing for even a pro-choice politician to sign on to.  (Bill Clinton, anyone?)  Thus making parental involvement statutes better (in contrast to repealing them; aside from lowering the applicable age to 16 instead of 18) may be where the action has to be just now.  Yet Rebouche imagines a coalition of “clinicians, lawyers, court officials, and young women” who might “share stories, find solidarity, and agitate for change.”  I am with her. It would be great to hear from coalition members to learn when and where and how this sort of respectful and productive talk is underway.



Carol Sanger Replies to Helen Alvare: Disagreement About Radical Equality

I am grateful to Helen Alvare for her thoughtful commentary, and for calling my text “elegant,” a special pleasure coming from a writer like Alvare. In her post, Professor Alvare describes my book as a “portrait of abortion as lived today in the United States within our legal and cultural frameworks, from the perspective of a deeply committed advocate of legal abortion.”  She is right both on the ambition of the book—to create a portrait, or what Michael Dorf has called a “guided tour of the practices and ‘culture’ of abortion”—and with regard to the author’s commitment to legal abortion. Indeed, I would go further and say that I am something more than an advocate of legal abortion: abortion is legal now and yet I still complain. This is because I think abortion should not only be legal but should not be made to feel or be experienced as though it were not. Nor should it be a matter of shame, secrecy or disrepute.

Yet About Abortion is not intended as “singing to the pro-choice choir.” To be sure, the book presents arguments about the price that women, and girls in particular, must pay for choosing abortion. But my examples are meant to introduce people unfamiliar with abortion regulation to how it all works. My thought is that even those who come to the subject from a pro-life/anti-abortion perspective might grimace on occasion as when they read about teenage bypass hearing or about mandatory ultrasound statutes. Indeed, Professor Alvare acknowledges that the various vignettes, most taken straight from case law, “invite more than a little sympathy for women.”  My hope is that either reaction—sympathy or grimace—might cause pro-life advocates to pause and reconsider how the law should treat women and girls in the circumstances of an unwanted pregnancy.

The book is not meant to change anyone’s mind about how a fetus should be characterized, whether as a person of the same moral status as a born person, or as a human being at an early stage of development, or even as an egg (l’oeuf) as the French do in the case of early abortions. This is a matter upon which people differ depending on their prior beliefs and commitments.  Yet I hold the view that partisans on both sides of the issue (to simplistically boil things down to only two sides) must in good faith attempt to grasp the essence of the other’s position in order for any civil discourse to proceed. Thus, I tried to show how the pro-life view of prenatal life—that it is a full-out person—is not wholly inaccessible to pro-choice people who, when carrying a wanted pregnancy of their own, begin to talk about and connect to the prenatal life less as a clinical fetus and more like their special fetus, or even their child.

As Robert George and Christopher Tollefson explain in Embryo: A Defense of Life, one cannot deny that a human embryo is human or that it is alive. Thus it is from a biological perspective, a human life, and not a frog. If Professor Alvare is suggesting that pro-choice advocates ought to be willing to acknowledge this, then I agree. But a human life is not a human being—a person—in a legal sense. Thus I disagree with her compiling “undocumented immigrants, prisoners on death row, Syrian refugees, women, or human lives before birth” into one category about whose human rights we must be equally concerned. I understand her to be saying that a human life before birth (or switching the perspective slightly, a human life from conception forward) is the same as the immigrant, the refugee, the prisoner. For me, a human life from conception forward is not the same as the immigrant, refugee, or prisoner. I do not deny that abortion ends some form of human life, whether embryonic or fetal: without question a termination of pregnancy ends–kills if you want, though not in a statutory sense—prenatal life. That is how abortion restores women to their non-pregnant selves.

Alvare suggests that in a country whose jurisprudence has “effectively stripped sex of its biological and emotional links with couple-union, future, family, promise, intimacy…and children,” it might well seem “that by the time we get to the question of abortion, it seems unkind, even shocking to raise up for reflection and decision this matter of the existence and value of human life before birth.”  But it hardly needs to be raised up for reflection and decision. Women today are well aware of the state’s position on the value of human life before birth. How can they not be?  Billboards and bumper-stickers reinforce the message that a fetus is “a child, not a choice”; women are required to listen to heartbeats before consenting to abortion;  women soldiers cannot get abortions in military hospitals;  and the President himself described (inaccurately but in primetime) the outright murder of  babies where “in the ninth month you can take the baby and rip the baby out of the womb of the mother.”  Moreover, I want to return to Alvare’s connection between sex and “its biological and emotional links with couple-union, future, family, promise, intimacy and children.” These are exactly the factors upon which women’s decisions to have an abortion are commonly based:  the absence of a couple-union that brought about the pregnancy, mothers’ obligations to their existing children, and the promise of a future and a family chosen by the woman herself.  It is simply (or not so simply) that some citizens find those issues lead to only one conclusion, and others do not.

Finally, with regard to my final chapter, Normalizing Abortion, Professor Alvare writes that “normalizing abortion rights as the way forward … is not an intellectually or legally or morally coherent response.”  Here some clarification may be in order.  I regard normalization as a strategy to bring discussion about abortion more in line with the practice of abortion: a decision women regularly and soberly make despite the perceived and actual risks of stigma and other harms.  My conception of normalizing is not offered up as a legal response to the issue except in that more open talk, even at the private level, may over time bring about more open talk at the political level as elected officials come to know that there is a great possibility of six (or fewer) degrees of separation between them and abortion.  The statistics are becoming familiar: one in three American women will have had an abortion by the end of their reproductive years.  Responsible pro-life advocates ought to know be aware of these figures, even in the abstract. A motto of the National Network of Abortion Funds is Everybody Loves Someone Who Has Had an Abortion.” The problem is that everyone doesn’t know that they do.  That is what normalizing is meant to accomplish.


Carol Sanger Replies to Lisa Pruitt: Urban Omissions

Lisa Pruitt’s generous critique of About Abortion has many phrases that warmed the heart of the book’s author.  She praises the book as “seamlessly cross-disciplinary,” noting that Girls and the Getaway: Cars, Culture and the Predicament of Gendered Space is one of her favorite law review pieces. (Mine too and it hardly gets read!)  Pruitt accurately pinpoints my “over-arching point regarding women’s agency and competency,” and praises the “clever parallels” drawn between bypass hearings and fault-based divorce proceedings, and between mandatory ultrasound statutes and third party tort liability for maternal injury upon witnessing the death of one’s child.  She endorses About Abortion’s “very powerful critique” of judicial bypass hearings, where the author “puts herself in the shoes” of the teenage petitioners, which I hope means that readers themselves feel the sting of humiliation visited upon petitioning minors.

Pruitt’s analysis was especially heartening because the examples she selected for discussion included the very passages that I had spent much time developing as I believed I was onto something.  And too, Pruitt’s own turn of phrase is just what one longs for in reading legal writing; “law’s often arbitrary silos” as a description of the unnecessary insularity of one area of law from another is what one might expect from the academy’s expert on the distinctive place of law in the lives of our country’s rural citizens.

So far so good.  But then Pruitt takes aim and finds in an otherwise a “wide-ranging, provocative, thoughtful and beautifully written monograph,” that something important is missing and lamentably for the lost opportunity, that About Abortion could have been better.  The blind spot she identifies is the omission of “spatiality, geography, [and] rurality” as factors necessary for a more complete and productive understanding of abortion as a cultural and legal practice throughout the United States, and not just in the crowded parts. At this point in Pruitt’s critique, the author’s once warm blood began to run very cold indeed.

It would be easy to respond (in snarky Sorry, Not Sorry tone) something like well, you can’t cover everything. Look at all the connections I did make.  I mentioned distances in Texas, didn’t I?  And so on.  But in fact, Lisa Pruitt drew my attention to what is a blind spot and one that had been brought to my attention several years ago while I was teaching Family Law at Columbia.  During a class on custody, I stood by as the class went to town on a father who let his son have a shot gun, to which the mother objected.  A young man came up after class and said he was from somewhere that was not New York but a place where people guns in their homes and rifles in the cab of the family pick-up as a matter of course.  (I taught in just such a place for two years before law school a scant ten miles outside of Ann Arbor.) This student had grown up with guns and didn’t think it a proper factor in making a custody determination.  I took the point at the time, but I let it slip out of sight, as regionalism does all the time in Family Law, and likely elsewhere.

But Pruitt draws our attention to something more specific than mere regionalism.  Her focus is on rural regions, those places we smarty-pantses (or what Pruitt identified as “coastal elites”) fly over with a kind of oblivion, even when it comes to the application of legal doctrine.  Pruitt observes that this is true even for the Supreme Court, who, when applying the substantial burden test in Casey to waiting periods in relation to where women lived, found them to be “‘troubling in some respects’ but insufficiently burdensome to invalidate the law.” Indeed, she points out that my own discussion of distances in Whole Women’s Health crunched into a problem of time, rather than a problem of location and the more comprehensive set of problems that rurality presents to women with unwanted pregnancies outside cities and suburbs.

We should also keep in mind that some women are assigned into rurality.  I have in mind women serving in the armed forces not uncommonly in remote bases in various states.  An amici brief, filed in Whole Woman’s Health on behalf of the Service Service Women’s Action Network And Retired Or Former Military Officers, explained that “the entire western half of the [Texas], covering over 130,000 square miles—in which five large military bases are located—would lack any abortion care providers at all.” If HB2 had remained in effect, the brief noted that service women at Goodfellow Air Force Base would have a three hour drive to San Antonio, 199 miles away, and this is without the added difficulties of obtaining a pass, arranging a timely appointment, and finding the funds.

Many of us do not attend to the urban/rural distinction as a filter that could be imposed on legal analyses in criminal law, tort law, child welfare law, family law, immigration, and certainly with regard to the laws and regulations concerned with reproductive services.  There are those in addition to Pruitt, who I have in mind, the brief submitted in Whole Women’s Health by The National Latina Institute for Reproductive Health and Madeline Gomez’s article More Than Mileage: The Preconditions of Travel and the Real Burdens of H.B. 2.

Pruitt is careful not to recite the mantra familiar to anyone who has sat through more than two faculty workshops: why didn’t you write the book I would have written?  She is not asking for her passion to be all of ours. But she makes the case that location, location, location is not just a suburban realtor’s phrase. It is a concept—a fact—that is crucial to understanding how lives are lived and political preferences formed according to where one lives. As Wendell Berry has recently written,  “[s]ince the 2016 election, urban liberals and Democrats have newly discovered “rural America,” which is to say our country itself beyond the cities and the suburbs and a few scenic vacation spots… [But] as apparently none of the enlightened ones has seen in flying over or bypassing on the interstate highways, its too-large fields are toxic and eroding, its streams and rivers poisoned, its forests mangled, its towns dying or dead along with their locally owned small businesses, its children leaving after high school and not coming back.”   Pruitt knows that each of problems implicates law, and her call is for the rest of us to pay attention.

As for About Abortion, Pruitt writes: “I can’t help grieve the lack of attention to rural Americans—especially low-income ones—whose lived realities are so little understood by, by those who shape litigation with respect to rights whose exercise implicates the traversal of distance (including voting!), those who may take public transportation for granted, those who do not subsist on poverty level wages.”  I think she should have the last word on this important point.


Carol Sanger Replies to David Pozen: Rules, Standards, Abortion

David Pozen begins his post by tearing through an avalanche of subjects packed into 14 pages early in Chapter 1, whose only connection to each other seems to be their (sometimes opaque)  connection to abortion.  Upon reading what he describes as a “whirlwind tour,” I too had to ward off a feeling of vertigo until I remembered that I myself had written these lines and in this way on purpose. They appear in a section called What Abortion is About and I wanted to show what abortion looks like across the culture if you don’t take it one thing at a time but let the entire “culture of abortion” wash over you all at once.  The idea was not only to identify how much in America is about abortion but also to experience it, even at a reader’s remove.  Happy to say, both Pozen and I recovered and I am grateful to him for diagnosing the spinning sensation as, in the end, producing “an enhanced sense of clarity about the arc of abortion regulation.”

In this response, I want to riff on three aspects of Pozen’s insightful critique. The first concerns secrecy, the second The Closet, and the third, distinctions between and application of rules and standards in the reproductive context.

Secrecy first. Although Pozen has written on the complications of deep secrects in government and its leaky leviathan, he accepts my characterization of privately held abortion secrecy on its own terms. He translates it thus:  “secrecy [in the context of abortion] means that … dubious, paternalistic or factually erroneous claims” about abortions harms “are able to circulate with less pushback” than would be the case “in a more open conversational climate.”  Flipping the perspective, secrecy means that claims about abortion’s benefits also go unspoken; even the phrase—“abortion’s benefits”—is politically dangerous.

While I have argued that it is the perceived or actual threat of harm that turns privacy into secrecy, I want to consider a further possibility about why women stay mum.  Keeping abortion secret may also be a matter of familiarity with nondisclosure in the realm of women’s bodies and how they function.  Women and girls are used to keeping body secrets starting perhaps with the development of breasts (with hunching and layering to hide them) and ending with HRT (hormone replacement therapy).  These are but the end points of women’s reproductive bodies. They bracket a spectrum that includes periods, missed periods, intercourse, miscarriages, and menopause. These all concern reproduction and what is sometimes referred to as reproductive failure.   Abortion is something much worse; not a natural “failure” but a deliberate decision not to cooperate with nature’s scheme, women’s destiny,   God’s will, and so forth.   Accepting these many sources of secrecy, abortion secrecy as a practice may be overdetermined.

I turn next to Pozen’s conclusion that, like other behaviors “coded as shameful or deviant,” abortion “is in the closet.”  I agree.  But what I am less clear about is just why this is so.  Two distinctions between abortion and other stigmas highlight the puzzle.  First, unlike “being gay,” say—which many consider a constitutive aspect of identity—“having had an abortion” is not “being” anything.  It is an event, an occasion, a procedure, a decision, a push-pin marking one moment or episode in a woman’s life. Yet abortion is converted in the prolife public narrative to a character flaw that sticks, unless one repents and even then I wonder whether as a social matter, not a theological one, if repentance really removes the taint. I am reminded of a Mary Tyler Moore episode from the 1970s where Mary was shocked to learn that Mr. Grant was breaking up with his girlfriend because he had heard she was “that sort of woman.”  Disgusted, Mary pushes Lou and demands to know, “Just how many men is a woman allowed to have before she becomes “that sort of woman”? He replies, “Six.”  The abortion answer is apparently one.

The second piece of the puzzle concerns abortion stigma, about which much has been written.   Yet unlike other recognized sources of stigmatization, abortion is neither a trait, a constitutive commitment, nor a chronic condition.  “Having had an abortion” is not even an apparent stigma.  The stigma that keeps women in the closet is thus self-imposed; it is fear of stigma should the word get out.  In this way, some women who choose abortion do more than comply with the unnecessary and humiliating laws around consent: they also internalize the suppositions of the legislative framework.  In this way, the laws that signal abortion as deviant enlist women in the cause.  If half of the 59,000,000 women who have had an abortion (starting with the ones who would have been, say 25, in 1973 and so are 69 today) would tell just two people, this might illuminate—if not defang—the closet in useful  ways.

A mass (and private) revelation by grannies might address another of Pozen’s insights: that the problem with pro-choice disclosures is less one of ignorance that it is “a refusal of empathy.”  This is a particular take on Kenneth Doka’s concept of “disenfranchised grief.” It is not only that the woman isn’t entitled to mourn or commemorate, should she so choose, but she isn’t entitled even to be understood.  Talk to the hand, ladies, because the ears aren’t listening.    Empathy might also function as incentive: if you act kindly to women of reproductive age who have terminated an unwanted pregnancy, they might do it again.  In this regard, there is something to be said for women past their reproductive years to step up; their (assumed) lack of sexuality removes sex from the equation and isn’t at least part of the opposition to abortion based on disapproval of non-procreative sex?   Were I an activist, I would stir up grandmothers, seniors, and pastor’s wives to come out, among friends, with granddaughters, in reading groups (try About Abortion!).

Finally, I turn to Pozen’s observations about rules and standards in the context of abortion.  Rules, he explains, “limit case-by-case judicial discretion through crisp ex ante directives;” in contrast, standards force decision makers to “to think hard about whether they are acting appropriately and why.”  However, Pozen shows the counterintuitive consequences of the distinction when a standard like “the undue burden test” is applied in the context of abortion.  The result has not been “sensitive and honest debate,” but as Pozen states, an invitation to “endless cycles of opportunism and obstruction.”

Rules/standards difficulties extend into the subsidiary reaches of abortion regulation as well. Consider the treatment of minors where a straight out rule—the age of majority—does the initial sifting regarding which rules will apply. All women must comply with waiting periods and the many other conditions required for consent. But for those under 18 years, these rules give way to standards.  A bypass judge must determine whether the pregnant minor is sufficiently mature and informed enough to be permitted to consent to an abortion.  And here discretion raises its hydra heads.  Judges in some states have found that have found that filing a petition in court to commence a legal hearing indicates sufficient wherewithal (my word) to warrant granting her petition.  Others, particularly in Alabama, have found that nothing less than contemplating the consequences of the decision for one’s mortal soul will do.

One easy way out of this “piling on” for minors—who must comply with waiting periods and the rest on top of the bypass hearing—would be for states to lower the age of majority for abortion consent to 16 so that at least older teenagers would not have to undergo what Texas bypass attorney Susan Hays has called the “give the little tart a lecture” bypass procedure.   After all, legislatures use variable ages of majority for minors all the time; they are allowed in a number of states at age 16 to consent to sex with another minor as well as to obtain birth control without a parent’s consent.

At the end of his post, Pozen says that “the relationship between legal doctrine and cultural practice in such a politically charged field [as abortion] may be poorly illuminated by abstract propositions about the comparative merits of rules, standards, or the like.”  But abortion as a subject of inquiry and of regulation turns everything topsy-turvy:  teenage girls held too immature to consent to abortion are left to become mothers;   women are required to bury or cremate aborted fetal remains; the  procedure is “abnormalized” through its omission from Medicaid.   These various maneuvers are assaults on normal modes of reasoning.  Unpacking the failure of traditionally reliable legal concepts is necessary to our collective efforts to appreciate what is going on and how to improve our own parries and thrusts.  This is going to be a long match indeed, and I thank Dave Pozen for getting some of it going here.



Carol Sanger Replies to Khiara Bridges: Medical Care and the “Down There” Problem

In the 1960s, a friend from ages ago went to a new gynecologist for a regular check-up.  As she lay there on the table, feet in stirrups covered with kitchen oven mitts in a gesture toward patient comfort, the doctor came in and said, “Hello, I am Dr. [Smith]. I am going to examine your body and then I will look ‘down there.’”  My friend replied, “’Down there’ is part of my body.”  (I can’t remember if she got up and left or not; it was the 60s and we were still fairly obedient.)

Whether  “down there” is part of one’s body for purposes of medical treatment is the question asked and very quickly answered by Khiara Bridges in her post “Abnormalizing Abortion.”  The answer is No, not if we use the term “medical treatment” to mean the treatment or prevention of all other medical conditions covered under Medicaid.  This was established under the Hyde Amendment, which bars federal Medicaid funds even for a pregnancy that endanger the woman’s health or life, or that was caused by rape or incest.  The “down there” issue has now become federal policy, as abortion is now a form of treatment literally segregated from the body politic.

Bridges uses About Abortion, and my interest in how abortion regulation tries to convince women not to terminate their pregnancies through moral suasion (and to punish women who do it anyway) as a point of departure toward other forms of regulation.  The Hyde Amendment isn’t a bit interested in moral suasion.  Instead, it sets a bright line rule at the poverty level that “coerces indigent women to carry their pregnancies to terms by leaving [the women] to scrape together the $300 to $3,000+ for their abortion procedures.”

Not only does the Hyde Amendment have actual power over an indigent woman by its refusal to fund an abortion procedure, but as Bridges powerfully points out, the denial of funding is rich with “discursive power” “insofar as it creates and legitimates discourses that describe abortion as ‘not healthcare.’”  Her point is that while I have focused on normalizing abortion, we ought to be attentive to just how and how forcefully law “abnormalizes” abortion by segregating it from all other healthcare.

By most people’s lights, abortion is a medical procedure even if one thinks the procedure should be illegal.  Its status as medicine is the basis of its regulation by the federal and state governments under the police power, that relic of 7th grade physics that still has purchase today in Constitutional Law.

Abnormalizing abortion through funding bans is of a piece with the battle to cover contraception under Obamacare, with the layers of regulation that treat it differently from all other procedures, and the global gag rule.  Moreover, the funding ban only applies to poor women, who are more often women of color, so that this form of maternal coercion, as Bridges points out, is tinged with race.


Carol Sanger Replies to Naomi Cahn and June Carbone

We all know the common practice of thanking those who have made a conference or symposium possible, often uttered at the end of the day amidst the shuffle of papers and scraping of chairs as everyone heads off for wine and cheese.  I would like to flip the order and begin rather than end with my heartfelt thanks to Naomi Cahn and June Carbone for organizing this on-line conference/symposium on my newly released book, About Abortion.  They have been generous, gracious, patient, and astute in everything connected with this edition of Concurring Opinions.  Even before participating in this symposium, I have been indebted to Naomi and June for their own collaborative scholarship, ambitious in scope, inventive in method, and powerful in presentation and substance.  Although there is much to choose from, I am thinking particularly of their two books, Red Families/Blue Families: Legal Polarization and the Creation of Culture and Marriage Markets: How Inequality is Remaking the American Family.

Their introduction to the Symposium states that I have attempted to provide the “legal infrastructure for abortion decision-making,” and “a richer foundation for public consideration of the issue [of abortion].”  This was exactly what I was after in writing this book.  To help dissect, challenge, reframe, and assess the arguments in About Abortion, June and Naomi assembled a phalanx of wonderful reviewers who have approached About Abortion from almost every angle (though no one bit too hard on the images!).  For years I have presented drafts of the book’s nine chapters, accepting the proposition that the sooner someone sets you straight or objects to a line of inquiry or says something that sounds wrong but you have to think hard to figure out why, the sooner the manuscript will improve.  What I did not realize was that even after the book has an ISBN number and your mother can hold a copy in her hands, there is much to learn about what you wrote:  how it is received by readers (rather than how you heard it in your own head); things you missed (despite years in the making); and profitable connections between your own text to doctrines, policies, and viewpoints outside one’s particular ken.

For their careful reading of and willingness to comment on About Abortion, I am deeply grateful to Helen Alvare, Khiara Bridges, David Cohen, Leslie Griffin, Linda McClain, David Pozen, Lisa Pruitt, and Rachel Rebouche.  I thank them heartily.  My specific responses to each are posted beneath each of their reviews.  I look forward to on-going conversations with reviewers and other readers.


Sanger’s Tour de Force on Abortion (with a Blind Spot for Geography)

We would expect nothing less from Carol Sanger than what we get from About Abortion: Terminating Pregnancy in 21st Century America: a wide-ranging, provocative, thoughtful and beautifully written monograph. As legal scholarship (if that is what Sanger intends it to be, and I am guessing she appeals to a broader audience than that), the book is “out of the box” because it is so extraordinarily, seamlessly cross-disciplinary. (Sanger is, after all, the scholar who brought us the  path breaking Girls and the Getaway:  Cars, Culture and the Predicament of Gendered Space (1995), one of my all-time favorite law review articles). As with her past work, Sanger’s prose is engaging, the breadth of literature she draws on sweeping, and the turn of phrase clever.  I am happy to report that this book is no doctrinal slog through the Supreme Court’s abortion law canon, though Sanger gives the germinal cases their due, along with a number of especially interesting ones from lower courts.

Near the outset of About Abortion, Sanger stakes out the territory she intends to cover and she articulates an over-arching point regarding women’s agency and competency:

This book is guided by a very different premise [from that of most abortion regulations and restrictions]. Women—even young women—understand very well what an abortion is. They understand that abortion ends pregnancy and that if they have an abortion, they will not have a baby: that is its very point. The significance of an abortion decision may differ from woman to woman and from girl to girl, but in deciding whether to continue a pregnancy, each will draw upon her own sensibilities, circumstances and beliefs. But as with other intimate decisions and commitments—who to marry, whether to pray, how to vote, what to do with one’s life in matters large and small—women themselves are best able to decide what is at stake.

As other reviewers in this forum have noted and detailed, Sanger takes up topics such as “Fathers and Fetuses: What Men Would Do,” “Sending Pregnant Teenagers to Court,” and “Abortion Privacy/Abortion Secrecy.” Even less conventional (as legal scholarship), though, are the chapters titled “The Eye of the Storm,” “Facing Your Fetus,” and “You Had Body, You Died.” In the first of these, Sanger analyzes the fetus as the eye of the political, cultural and religious storm about abortion. Here she explores images of fetuses from different cultures, how these images have evolved over time to look more like babies (or even little adults, with softened features), and the purposes to which fetal imagery has been put. The chapter features about a dozen illustrative images, some from outside the U.S., laying the groundwork for the next two.

In “Facing Your Fetus,” Sanger draws a clever parallel between mandatory ultrasound laws and the law of negligent infliction of emotional distress, in particular the bystander cases that typically featured mothers traumatized at having seen their child seriously injured or killed in an accident. As Sanger observes, both contexts and laws “draw upon a deep reserve of sentiment about what mothers are like and what causes them harm.” (p. 109) (It is worth noting that this is hardly a singular instance of Sanger making connections across law’s often arbitrary silos, as when she compares “abortion secrecy” to a germinal invasion of privacy (tort) case or when she compares the indignity of a minor having to air the details of her need for an abortion to the indignity of going to court for a divorce in the era when doing so required specific and detailed assertions of “fault,” e.g., cruelty, adultery).

In “You Had Body, You Died,” Sanger again uses images, this time to juxtapose women’s loss by miscarriage or even death of a child against the experience of abortion. This lays the groundwork for her discussion of the Supreme Court’s decision in Gonzales v. Carhart. Sanger is exploring here, as in the prior chapters, how “imagery acquires meaning in abortion,” (p. 147) including how the Supreme Court in Carhart used the imagery evoked by the written word (describing intact dilation and extraction) to justify its decision.

Much as I was enthralled by Sanger’s engagement with imagery and meaning in these chapters, I also appreciated the more practical turn she takes in “Sending Pregnant Teenagers to Court.” Here, Sanger builds on some of her earlier work and grapples with “on the ground” workings and consequences of abortion regulation, specifically judicial bypass for minors. Sanger surfaces an array of illustrations, mostly from reported cases but also from interviews with judges, bypass attorneys, and advocates, regarding how these laws undermine young women. One way the disservice occurs is by misunderstanding and harshly judging these teenagers, like the one in Texas who told the judge,

if I really put the cards out on the table and look through them—I—I having a baby right now would probably stop 75 percent of what I want to do … I know—I’m—like I said, I’m very busy. I have a lot of high goals, and having a baby would stop me from having them.

The judge used the “very busy” language against the young woman, ruling that—at least in part because of the way she had expressed herself—she “was not mature enough to make the [abortion] decision without parental guidance.” (p. 171). Sanger puts herself in these teenagers’ shoes, offering a very powerful critique.  She also credits the many organizations around the country, e.g., Jane’s Due Process, who help teens navigate these processes, and she notes recent legal limitations (Texas, 2016) that prevent teens from availing themselves of the anonymity an out-of-county/non-local filing and video-conference appearance might afford them.  (This is one point where Sanger might have noted the legal relevance of rurality, theorization of rural difference, see below).

In sharp contrast to this very textured and empathic discussion of what young women are up against in the judicial bypass context, About Abortion says far less about poor women seeking abortion and less still about rural women (often also poor) doing so. Sanger includes an obligatory discussion of Harris v. McRae (1980), the Supreme Court decision that upheld the Hyde Amendment’s ban on the use of federal funding for abortion. (p. 28) Later, regarding the run up to the Supreme Court’s decision in Whole Woman’s Health v. Hellerstedt (2016), Sanger acknowledges that the proliferation of TRAP regulations (Targeted Regulations of Abortion Providers) like the regulations at stake in that case (Texas H.B. 2) had returned the nation to a landscape with a “pre-Roe hue, with abortions available in some states and barely available in others, wealthy women traveling again, and poor women making do” (p. 35).

Otherwise, beyond a passing reference to “zip code jurisprudence” (p. 33), the book does very little to acknowledge the significance of geography to abortion access—including in relation to the “undue burden” standard adopted in Planned Parenthood of SE Pennsylvania v. Casey (1992) and the numerous federal courts who have since applied that standard. Admittedly, as a legal geographer, this is my pet issue, and it would be churlish of me to suggest that Sanger should have written the book I would have written. Yet it is a perennial surprise to me that scholars of reproductive rights and reproductive justice pay so little attention to the plight of rural women, devote so few scholarly resources to the geography angle on the exercise of rights.

The petitioners’ brief in Casey mentioned “low-income, young, rural or battered women,” three times in relation to the informed consent and waiting period laws imposed by the State of Pennsylvania. Yet the Casey plurality opinion failed to mention rural women at all except in a quoted finding of fact from the district court, which it ultimately dismissed. That plurality concluded that the trial court’s finding that “for those women with the fewest financial resources, those who must travel long distances, and those who have difficulty explaining their whereabouts to husbands, employers, or others, the 24-hour waiting period will be ‘particularly burdensome’” was “troubling in some respects” but insufficiently burdensome to invalidate the law. Many federal courts in the wake of Casey similarly dismissed the burden that waiting period/informed consent laws imposed on those living far from abortion providers.

Next, of course, came the Supreme Court’s 2016 decision in Whole Woman’s Health v. Hellerstedt, in which the Court finally took distance seriously—although it’s worth noting that it took vast Texas distances of 300-to-500 miles to get the Court’s attention. In short, Whole Woman’s Health put some teeth back into the undue burden standard, and Sanger notes the salience of travel and distance to that holding. In Whole Woman’s Health, Sanger writes, the Supreme Court balanced Texas H.B. 2’s “near non-existent medical benefits” against the “longer travel times, more time away from home, increased costs of child care, and the greater risk of being found out put in play by the lengthier process.” (p. 35).

Yet Sanger reserves her passion and a long quote from the Supreme Court opinion for another issue incident to the clinic closures wrought by Texas H.B. 2: the long wait times and the “crammed to capacity superfacilities” where women would have been expected to get abortions had the Supreme Court upheld the Texas regulations, leading to the closure of all but some half dozen Texas clinics. This mirrors the shift in media focus as Whole Woman’s Health made its way from the federal district court to the Supreme Court—a shift from a focus on distance to a focus on wait times as the dwindling number of clinics struggled to accommodate Texas’s 5.4 million reproductive-age women. It was a shift in focus from space to time, effectively from rural to urban.

The difference between Sanger’s passionate critique of sending teenagers to court in judicial bypass procedures and her brief matter-of-fact recital of the role of travel and distance in Whole Woman’s Health is striking. Again, Sanger’s passion need not be mine, but I can’t help grieve the lack of attention to rural Americans—especially low-income ones—whose lived realities are so little understood by coastal elites, by those who shape litigation with respect to rights whose exercise implicates the traversal of distance (including voting!), those who may take public transportation for granted, those who do not subsist on poverty  level wages. If the 2016 Election has taught us anything, it is surely that the narrating classes need to see rural Americans in all of their complexity—and that rural Americans resent their invisibility on the national stage. In short, rural America needs an advocate (better yet, a dozen or two, in an array of contexts) as eloquent and passionate as Sanger is generally about abortion.

This relative neglect of spatiality, geography, rurality should not, of course, dissuade anyone from reading About Abortion. Quite the contrary: the book is a tour de force, perhaps Sanger’s magnum opus. She accomplishes a great deal, in her inimitable way, and with elegance. It is an important book, and it deserves a wide audience, across many disciplines.