by Drew Halfmann. Chicago: The University of Chicago Press, 2011. 353pp. Paper, $35.00. ISBN 978-0-226-31343-6
Reviewed by Gloria Cox, Honors College and Department of Political Science, University of North Texas. Email: Gloria.Cox [at] unt.edu.
While the practice of abortion is as old as human society, abortion as a political issue is a fairly recent development, and it was not of much interest to policymakers or even those individuals and groups who would influence government, until recent decades. It is not surprising, then, that such a complex, contentious, and ongoing issue would inspire scholars to examine it in hopes of providing new insights and understandings. Drew Halfmann takes up the issue in his book Doctors and Demonstrators: How Political Institutions Shape Abortion Law in the United States, Britain, and Canada, providing analysis primarily in terms of political institutions. In this relatively short book of just over 200 pages (although with more than 100 additional pages of notes) the author takes an historical perspective and also makes comparisons across the United States, Great Britain, and Canada. This is truly an ambitious agenda, particularly for such a complex subject, and it is clear that the author has carved out for himself a very tough assignment.
At the outset, Halfmann provides a framework for his book, beginning with a statement of his own support for legal abortion. As he rather eloquently puts it, “[Control over their reproductive lives] can help [women] protect their livelihoods, their health, their relationships, and their dreams” (p.1). His perspective is an interesting one to those of us accustomed to hearing abortion analyzed in terms of religion and morality or as a constitutional right. He argues that the human female has a long reproductive life and that over a lifetime a woman will have, on average, two contraceptive failures. That being the case, the legality of abortion is essential, because “Even with the best contraception, women cannot achieve full reproductive control without access to abortion” (p.1). By providing an argument based on medicine and science, as opposed to religion or constitutional rights, Halfmann, while favoring abortion rights, smoothly avoids agreeing with either side in the United States.
Halfmann deals with abortion only in the modern context, beginning with the Long Sixties and moving right into [*340] recent times, with only very limited reference to the full historical context. A brief summary of early American practices might be interesting and useful, particularly for those readers not already immersed in literature on the issue. Abortion was legally practiced in Colonial America and the United States until the latter part of the nineteenth century, and it was commonly accepted, though not by all, of course, that abortion could take place until quickening, or movement of the fetus. Potions promising to end pregnancy were openly advertised and sold, and women often knew of someone in the community willing to carry out an abortion procedure. Eventually, abortion became illegal under a variety of state laws, and remained so until a few states began to change their laws in the 1960s.
Doctors and Demonstrators is a book about the abortion law reform movements in the United States, Great Britain, and Canada, nations with a common heritage and similar political values. Halfmann spells out how abortion policies were reformed in each nation about the same time, making the procedure legal, although under somewhat different circumstances from one to the other. After establishing that reform took place in all three nations, he devotes the remainder of the book to discussing what has happened since reform, centering his analysis on political institutions to explain why abortion has remained an important topic on the public agenda in the United States while becoming a settled issue of little interest and importance in Canada and Great Britain. Halfmann argues, in fact, that differing institutions, especially political parties, produced reform results that kept abortion on the political agenda in the United States and off the agenda in Canada and Britain.
Of great importance to Halfmann’ s analysis is the process by which abortion policy reform took place in these three nations. In Great Britain and Canada, abortion reform was a legislative process, with changes shepherded by the party in power. The responsible party system that allows party leaders in Canada and Britain to retain centralized control of the legislative agenda provided the opportunity for the party to frame the issue as they wished, make reforms, and then keep the issue out of sight. Additionally, reforms enacted by the government through this process had a sense of legitimacy, particularly because abortion was construed as a medical matter rather than a rights or morality issue. Adding to the policy environment was the fact that parties in Britain and Canada did not divide over the issue; indeed, party leaders of all parties have generally taken the stance that Members of Parliament must decide for themselves how to address abortion questions. That position, along with the power of party leaders to control the governmental agenda, has meant that abortion policy has received little attention in Britain and Canada since reform. In fact, in Canada, the provinces and the government passed the issue [*341] back and forth until laws on the books were allowed to expire without fanfare.
Halfmann contrasts that process with what happened in the United States where it was a Supreme Court ruling that had the effect of reforming abortion policy by declaring a state law unconstitutional. Unlike a legislative body, the Supreme Court does not engage in consensus building and incremental change. Landmark rulings, especially those that catch the public by surprise, can inspire strong opposition, and that is what happened following the decision in Roe v. Wade. After Roe, a woman in the United States could simply decide in early pregnancy to have an abortion – without the approval of a doctor or committee of doctors. Moreover, she could have the procedure in a clinic rather than a hospital. The sense of legitimacy that attached to the process in Canada and Britain was missing in the United States. Adding to concern about the ruling was the fact that Roe rested on Griswold v. Connecticut, a 1965 Supreme Court ruling that declared the existence of a right of privacy, although such a right is not explicitly mentioned in the Constitution. According to Halfmann’s analysis, the role of institutions is very strong in abortion policy reform, so opposition to the Roe ruling should be seen as the groundwork for the political battles that have remained to this day.
Halfmann also discusses the different nature of political parties in the United States, where parties are highly decentralized, to those in Great Britain and Canada, where they are highly centralized. The grassroots nature of U.S. parties makes them open to movements that could never make reach a centrally controlled agenda. Additionally, the existence of fifty state governments and their thousands of cities and counties provides an open system for involvement of people who have passion for a particular issue and want to become involved in policymaking. That is exactly what happened with the abortion issue in the United States, with abortion opponents running for state and local offices and building substantial power from the ground up.
The author of Doctors and Demonstrators carefully considers the issue of power, too, most importantly in terms of decisions about gatekeeping. Following reforms in Canada and Britain, physicians retained the final say on who could have an abortion. This was not a smooth process, of course, because the grounds approved for abortion were much broader than just medical ones. They also included mental health grounds that can be more difficult to assess than physical issues, and there could be economic reasons, too, such as the family could not afford another child. Least acceptable (then as now), social concerns might be present, including the fact that the pregnancy was the result of an affair or the woman simply did not want a child. Even though these processes kept doctors in charge as gatekeepers in Canada and Britain, the [*342] cumbersome nature of the reviews meant they would eventually be abandoned as just too onerous. The result was that abortions became more available over time in Canada and Britain even while they were becoming less available in the United States.
Power was also at stake in the discussions about where abortions could take place, and in Canada and Great Britain, the decision was that abortion is a medical procedure that should take place in a hospital. That had implications, of course, because hospitals could choose whether to allow abortions and many did not, so availability was limited. And money was at stake, too, because if only hospitals could provide abortions, there was nothing to keep them from requiring expensive tests and a three-day stay. Contrast that with the United States which allowed clinics to perform abortions. Many clinics were set up in the United States just for the purpose of providing abortions, which had the unintended consequence of allowing protestors to identify a clinic’s doctors and clients, and to demonstrate or even initiate violence against them.
It was a pleasure to read Halfmann’s analysis of the factors that influenced the thinking of Justice Blackmun who wrote the Opinion of the Court in Roe (pp.87-92). Halfmann follows up on this excellent discussion by showing how the states have been key players since 1973 in attempts to dismantle the rights set forth in Roe, and have, indeed, been quite successful as state legislatures adopted various restrictions including spousal notification, parental notification for minors, waiting periods, and compulsory counseling. These state laws challenging Roe were ultimately reviewed in the courts, with some reaching the Supreme Court. As Republican presidents nominated justices who were likely to oppose ROE, the Supreme Court, while refusing to overturn Roe, began to approve restrictions on abortion. With extra requirements for getting an abortion, the small number of doctors performing the procedure, and unavailability of clinics and doctors in many geographic areas, abortion is far less available now than it was in the years following legalization.
Is there one factor that accounts for abortion remaining an important and divisive issue in the United States but not in Great Britain or Canada? According to Halfmann, it was largely the politicization of the abortion issue in the United States that resulted from the feminist movement on one hand and the Christian Right, mostly Catholic groups on this issue. Because of the power of these groups and their ongoing rhetoric on the issue, political parties had little choice but to line up on one side or the other. By 1976, both major U.S. parties had platforms with opposing views on the issue (p.146), and by 1980, the issue played an important role in presidential politics. Ultimately, a huge chasm developed between the parties on this [*343] issue, and it endures to this day. As abortion became a party issue during the 1970s and 80s, many politicians switched sides on the abortion issue to be in line with their party. One such example is Richard Nixon’s switch in 1971, an early move made on the advice of Nixon advisor Patrick Buchanan (p.146).
In Doctors and Demonstrators: How Political Institutions Shape Abortion Law in the United States, Britain, and Canada, Halfmann provides an interesting and absorbing analysis of abortion reform and how the issue played out in Great Britain, Canada, and the United States. His view that institutions were the key players in the differing developments in the United States versus those in Canada and Great Britain is a powerful one in light of his arguments, making this a book well worth reading.
Griswold v. Connecticut 381 U.S. 479 (1965).
Roe v. Wade 410 U.S. 113 (1973) .
Copyright by the Author, Gloria Cox.