Vol. 27 No. 7 (September 2017) pp. 109-112

ABOUT ABORTION: TERMINATING PREGNANCY IN TWENTY-FIRST CENTURY AMERICA, by Carol Sanger. Cambridge, MA: Harvard University Press, 2017. 320pp. Hardcover $29.95. ISBN: 9780674737723.

Reviewed by James Daniel Fisher, Department of History, Politics, Languages & Cultures, Edinboro University. Email: jdfisher@edinboro.edu.

Carol Sanger’s ABOUT ABORTION examines “how women confront and decide about unwanted pregnancy within the complicated structures of constraint—personal, cultural, legal—that frame the issue of abortion in modern America” (p. ix). As such, it is not directly or primarily a study of the law. Sanger notes, however, that any worthy study of abortion politics in the United States must involve some legal analysis. American abortion law, furthermore, simultaneously reflects and affects larger political and social forces and itself cannot be understood without a broad examination of those forces. For that reason, ABOUT ABORTION is an important complement to books that engage in narrower jurisprudential analyses. It is an excellent example of how to unlock insights about law and politics by disregarding disciplinary boundaries and exploring all of the various dimensions of the human condition necessary to gain leverage over a difficult and irreducibly complex issue.

Sanger’s main empirical conclusion is that “the secrecy surrounding women’s personal experience of abortion has massively, though not irreparably, distorted how the subject of abortion is discussed and how it is regulated” (p. xi). This secrecy is the result of traditional stigma against abortion. That stigma has been exacerbated in recent years by “visual technology,” like ultrasound machines, being used “opportunistically” by anti-abortion activists to create a “visual politics” that advances the view of the fetus as a person with a right to life. At the same time, the individual experiences of women considering or having an abortion are pushed further from the realm of acceptable public discourse—a phenomenon Sanger calls “abortion silence” (p. 67). This tilting of the intellectual and emotional playing field of abortion politics—or, put another way, the foregrounding in the public consciousness of the fetus-as-child and pregnant-woman-as-mother—results in laws that Sanger concludes are harmful, like mandatory ultrasound requirements for women seeking abortions, and “judicial bypass” procedures for minor women who want to obtain an abortion without obtaining consent from, or giving notice, to a parent.

The “silence” around the individual experiences of abortion patients (that would make more clear the nuanced and complicated contexts within which women make abortion decisions), also contributes, in Sanger’s view, to the common view of abortion “as war, as struggle, as clash, as battlefield” (p. xiii), a simplified and unproductive public discussion, and a politics and law of abortion framed by false dichotomies.

Sanger would like to find a way to “normalize” the public discussion of abortion. “Normalizing” in this sense would involve reframing abortion as a “common medical procedure” (which it is). This would, in Sanger’s view, lower the temperature around the discussion of [*110] abortion, allowing for people of diverse views to discuss and truly comprehend the mindset of others, including the fine-grained reasons women decide to have abortions; their sometimes-mixed views about those decisions; and the multiplicity of ways that people understand what the fetus “is,” depending on the context.

Sanger does not consider normalization a panacea. Still, a change in the way people talk about abortion could positively affect the regulation of abortion decision-making, which, to Sanger, encourages women to feel “shame and apprehension” (p. xv). Ideally, abortion regulations would give space for “the kind of quiet dignity that usually attaches when women and men make important life-changing decisions” (p. xv).

ABOUT ABORTION does very little in the way of recommending how normalization of the discourse toward abortion-as-common-medical-procedure would occur, especially in the face of what I expect would be fierce anti-abortion resistance to any notion of abortion as “normal” (as a normative matter, even if it is, empirically, a relatively common phenomenon). This does not, however, detract from the power of Sanger’s empirical analysis.

In terms of organization, ABOUT ABORTION simultaneously establishes Sanger’s empirical claims and models the kind of subtle discourse that she thinks would be more productive and less harmful to individual pregnant women.

One of the pleasures of ABOUT ABORTION is the way Sanger draws from and ties together an incredibly wide range of material. Unsurprisingly, Sanger analyzes judicial decisions, legislation, the scholarly work of lawyers and political scientists, and news articles on a variety of controversies. The book really comes alive, however, when Sanger mines sociological and anthropological studies; novels and poems; illustrations from medieval and early modern texts; old photographs; Japanese spiritual rituals; ancient and contemporary statuary; art installations; and fetal dolls. Even Sanger’s use of legal texts goes well beyond those cases or statutes directly touching on abortion. Sanger draws insight about abortion-related cultural views by examining controversies in immigration law, asylum policy, criminal sentencing, employment law, First Amendment rights of prisoners, custody disputes, and the rules of evidence.

Sanger uses the first chapter of the book to establish the range of issues and presuppositions that influence the law and politics of abortion—for example, beliefs about sex and gender roles—and the second chapter of the book to review the concomitant development of American abortion law, focusing on the period from ROE V. WADE (1973) to WHOLE WOMEN’S HEALTH V. HELLERSTEDT (2016).

In the third chapter Sanger distinguishes between abortion “privacy” and abortion “secrecy” in order to “demonstrate how abortion silence works” (p. 47). Sanger argues for the value of a woman’s privacy/autonomy regarding the decision whether to have an abortion and to whom to reveal information about an abortion. Privacy can be “empowering … as an aspect of choice and self-definition” (p. 68). Secrecy about abortion, on the other hand, is almost a form of coercion from external forces due to a social stigma about abortion (one wants to hide one’s abortion experience because of a fear of negative consequences). The felt need for secrecy has a negative effect on a woman’s abortion experience and [*111] larger quality of life; if nothing else, it may discourage a woman from having a desired abortion altogether or serve as a form of humiliation or punishment for having one. In a variety of ways, anti-abortion activists and government actors have used the threat of exposure as a means to discourage abortion—and used the tilted public discourse (that favors anti-abortion framing of fetal imagery) to enact restrictive laws that further promote abortion secrecy.

Before critiquing specific abortion regulations, Sanger engages in a wide-ranging analysis of the image of the fetus in politics and culture. Sanger’s goal “is not to pin down an objective definition of what a ‘fetus’ is but to consider what ‘fetus’—as word, entity, concept—has come to mean, and to connect the variety of meanings to the variety of ends these meanings serve” (p. 76). To that end, Sanger employs a fascinating variety of cultural materials to sketch out the historical development of images of the fetus and for what purpose they were used. More directly related to abortion, Sanger (consistent with many other scholars) concludes that anti-abortion activists, harmonizing their efforts with other cultural moments and motivations, have been relatively successful in conflating the fetus in the public mind with a born child who is, in utero, already “a participating member of the family” (p. 80).

ABOUT ABORTION then turns to explore two policies that ostensibly ensure that a woman makes a fully “informed” decision to have an abortion. Sanger first critiques the requirement of some states that women must undergo an ultrasound before having an abortion (with possible additional requirements, such as making the sonographer describe various features of the fetus to the patient). Sanger concludes that mandatory ultrasound is not really about ensuring informed consent. Instead, a mandatory ultrasound is a “transparently manipulative” attempt to force a woman who has decided to end her pregnancy to make a leap to seeing her fetus as a child and seeing herself as a mother (p. 111). To Sanger, mandatory ultrasounds are intrusive and coercive, essentially requiring women to “offer up the content of their bodies in the form of an image for inspection before the law permits them to end a pregnancy” (p. 111).

Sanger also critically examines the “judicial bypass” process. Many states do not permit a minor to have an abortion unless she gives notice to a parent or obtains consent from a parent. A minor can get around the notice or consent requirement by seeking the permission of a local judge. Sanger examines both bypass requests that have been denied (describing several examples of judges clearly refusing to grant a bypass under any circumstance) but also examines judicial reasoning in the vast majority of cases where the bypass is in fact granted.

Sanger concludes that the bypass process, despite being akin to a rubber stamp (and in that sense a “success” for minor women seeking abortions), still inflicts harm on minor women through its emotional intrusiveness; the possibility it creates for publicly ‘outing’ the minor as someone who sought or obtained an abortion; and delays it causes in obtaining an abortion. Judicial bypass is, in other words, its own version of “the process is the punishment.” It constitutes “the misuse of the legal process to harass pregnant minors” (p. 159) and, in doing so, negatively affects the socialization of young women to the law and the legal process.

Sanger delves into several other topics before concluding with a discussion of [*112] normalizing abortion discourse. The study of each topic contributes to the overall argument of the book, but some more directly and primarily than others. A few chapters are clearly in service of Sanger’s primary thesis, and other chapters (on mandatory ultrasound and the judicial bypass process) are direct examples of the policy relevance of her concerns. Even in these chapters, however, Sanger takes on facets and angles of a given phenomenon that have value more for their interesting nature than for their arguably tangential contribution to the larger aim of the work.

For example, Sanger takes a chapter to examine several innovative and clever forms of evidence in order to compare the motivations and reasoning of men who are forced to make a decision about ending unborn life with those of pregnant women. The basic upshot of this chapter is to conclude that women are criticized for using variables in their abortion decision-making calculus (for example, financial or familial considerations) that men also employ in analogous situations. This is an important finding but rather far afield from the rest of the study.

Another chapter distinguishes between “regret” of an abortion and various types of “loss” one may feel from an abortion (that nonetheless do not make one regret having the abortion). This is an important distinction, because “loss” from an abortion is often mistaken for “regret” of abortion by anti-abortion advocates, and, for that reason, pro-choice advocates are often reluctant to acknowledge any kind of negativity associated with women’s experiences of abortion. This results in an oversimplified understanding of abortion experiences. The balance of the chapter is devoted to a fascinating description of the history of "artifacts of consolation" for young children (like postmortem portraits and "spirit" photos) that have contemporary analogues in photos of and memorial services for stillborn children. While the chapter's main assertion is important, the material on artifacts of consolation seems superfluous, as Sanger convincingly describes and explains the distinction between abortion loss and regret in a few cogent pages. 

That being noted, I’m not sure that these tangential analyses are ultimately a negative quality of the book. Because of its incredible diversity of examples, breadth of examination, and richness of analysis, reading ABOUT ABORTION produces a cumulative edifying effect. In many ways, the book is more convincing due to its richness, despite its meandering nature. In addition, Sanger’s writing is consistently accessible, clear, and elegant without sacrificing analytical sophistication. Beyond its inherent value, ABOUT ABORTION will be useful to scholars looking for an overview of the legal and cultural landscape of contemporary American abortion politics. It could also be successfully assigned, in whole or part, to advanced undergraduate students, who would benefit from its refreshing interdisciplinary approach and methodological innovation.


ROE V. WADE. 410 U.S. 113 (1973).


© Copyright 2017 by author, James Daniel Fisher.