Donald T. Critchlow. Intended Consequences: Birth Control, Abortion, and the Federal Government in Modern America. New York: Oxford University Press, 1999. x + 307 pp. $30.00 (cloth), ISBN 978-0-19-504657-1.
Reviewed by Julian E. Zelizer (State University of New York at Albany)
Published on H-Pol (June, 1999)
Donald Critchlow is one of the deans of American public policy history. During the past ten years, he has played a crucial role in the development of the field. Most important, he is the founder and senior editor of The Journal of Policy History, the main outlet for policy historians. Moreover, Critchlow has published numerous books and articles that provide shrewd insights into how historians contribute to public policy analysis. Operating within a profession that since the 1960s has marginalized government institutions and public policy, Critchlow's accomplishments are immense.
Intended Consequences is an extensively researched and well-argued book. It offers a model for public policy historians who seek to integrate their research within larger narratives about the American past. This book traces the complex history of the family planning movement and its policies between World War II and the present, with special emphasis placed on the years between 1965 and 1974. Critchlow frames his narrative within four larger themes. First, he argues that the relative influence of mass movements and political elites differed at various stages of the policymaking process. Second, he contends that family planning policies often accomplished what its creators intended, thereby challenging the conventional wisdom on the inevitability of unintended consequences. Critchlow provides many striking statistics that support his claim that family planning policies curtailed global population growth and expand the use of contraception devices. Third, Intended Consequences claims that the success or failure of policy activists is contingent on how their objectives mesh with the "larger culture and the social mores and values of the society." Finally, Critchlow rejects the type of historical analysis that pits "good guys" against "bad guys." Rather, he urges historians to understand experts and activists on their own terms.
Critchlow presents three distinct stages to family planning policy. The first took place between 1945 and 1964. During this stage, a family planning policy network emerged that aimed to reduce global population growth. This upper-class, largely white, protestant, network originated in the world of business, government, and foundations. There were serious divisions within this elite network: some called for coercive action to control populations (Hugh Moore), others emphasized research and education on contraception (John D. Rockefeller III), while another faction championed family planning as a woman's right issue (Planned Parenthood Federation of America). The latter, Critchlow argues, was not the dominant faction until the 1970s. Despite these divisions, there was a shared consensus that controlling population growth would eliminate the world's most pressing problems, ranging from communism, to food shortages, to chronic poverty. These advocates operated through a small group of interconnected organizations that included the Population Council, Ford Foundation, Population Crisis Committee, and Planned Parenthood. Popular books such as William Vogt's Road to Survival also warned of overpopulation. Finally, private research played a crucial role in this stage through the development of demographic expertise as well as through the promotion of medical research on contraception (supported largely by the Population Council since the federal government and the pharmaceutical industry were quite hesitant to conduct this type of research).
At this stage, neither Democrats nor Republicans wanted to address population control for fear of offending the Catholic Church of America. President Eisenhower organized a presidential commission which supported U.S. money for family planning through military aid programs. In the end, however, the president refused to act on the proposal, which was unveiled in an election year. Like Eisenhower, Kennedy moved hesitantly. Thus, the core support for population control emanated from the policy network itself. Of all the members, John Rockefeller III was the most influential figure in shaping this network, according to Critchlow. Rockefeller dedicated much his life to this cause after being shocked by conditions in Africa and Asia following WWII. Rockefeller founded the Population Council in 1952. Frederick Osborn and Frank Notestein lead the Council as it gained international prominence. Besides funding population research and conducting public opinion campaigns, Council programs abroad encouraged the use of contraception. At this point, it would have been helpful if Critchlow examined how the legacy of Nazi policies influenced the politics of family planning. His evidence suggests it played an important role. For instance, Critchlow quotes one individual who warned of a Population Council report: "Frankly, the implications of this, while I know are intended to have a eugenic implication, could readily be misunderstood as a Nazi master race philosophy" (p. 23). Years later, in the middle of the 1960s, black nationalists would fiercely attack family planning programs for threatening their communities with racial "genocide."
The second stage of this policy history takes place between 1965 and 1973 when the movement shifted focus from international to domestic policy. The policy network lobbied the Johnson administration for population control as a means of reducing welfare costs and out-of-wedlock births. But Johnson also refrained from supporting this policy for fear of stimulating a backlash among Catholics. By this time, for threatening their communities. Nonetheless, the policy network continued to promote their ideas through an intense public relations and lobbying campaign. Articles, for example, appeared in mainstream magazines such as Redbook and McCall's while overpopulation received widespread attention with the publication of Paul Ehrlich's The Population Bomb (1968). Even popular fiction (Quality of Mercy, Make Room! Make Room!, and Logan's Run) popularized these concerns.
Critchlow claims that family planning also found support from changing cultural attitudes about sexuality in this period. Sexuality became more mainstream during the 1960s as was evident in publications such as Helen Gurley Brown's Sex and the Single Girl (1962), the youth culture that blossomed across the nation's college campuses, and the Supreme Court decision Griswold v. Connecticut (1965) that legalized the sale of contraception. With the introduction of the Pill, moreover, contraception became more widespread than ever before. This sexual revolution facilitated an acceptance of family planning policy within the United States. Despite the Vatican affirming in 1968 its opposition to artificial contraception, many American Catholics softened their position toward contraception.
Partly as a result of the network's lobbying efforts and a new cultural environment, Johnson supported new family planning initiatives. In 1965, the president included a statement about population control in his State of the Union message to Congress. Initially, Johnson encouraged agencies to undertake efforts without new legislation. Without a unified agency handling this responsibility, family planning fell under the jurisdiction of numerous bodies including HEW, the Interior Department, and Defense. Critchlow suggests that a single agency would have created more centralized control, institutional expertise, and administrative capacity for a bolder program. When John Gardner took over HEW in 1966, he allowed states to apply for federal grants to finance family planning. One year later, over thirty states had established family planning services. Direct legislation soon followed. In 1967, Congress passed the Social Security Amendments. Representatives Bush (R-Texas) and Schneebeli (R-Pennsylvania) inserted a provision that allocated federal money for state and private planning programs; the programs were thus linked to the War on Poverty. Congress passed the Family Planning Services and Population Research Act of 1970, which Nixon supported, mandating state family planning programs. The Nixon administration raised funding levels for these state initiatives.
In a particularly insightful chapter, Critchlow explains how foundations were crucial to implementing family planning. Foundations picked filled a void created by the underdeveloped bureaucratic infrastructure of the American welfare state. Although sometimes successful, these programs encountered intense local opposition, under-enrollment, and corruption. Still, the fact that Congress enacted these programs constituted an important achievement.
Ultimately, abortion fractured the movement and transformed the politics of family planning. Until the final stage, between 1973 and 1999, family planning meant contraception and sterilization. But during the final period, family planning increasingly meant abortion. Family planning was now defended on the basis of women's rights, not anti-poverty. At the state level, the movement for legalized abortion took hold between 1970 and 1972. With the 1973 Supreme Court decision legalizing abortion, family planning became a heated and partisan political issue. Abortion changed family planning from a population question to a women's right issue: family planning now meant abortion, as much as contraception. Abortion also shifted the focus of debate away from elite circles and toward the grass roots.
As the issue became more polarized, some in the family planning movement abandoned the cause. Most dramatically, Rockefeller publicly supported new research that credited other factors, such as economic development and women's status, for playing a much more important role in alleviating world poverty than population control. As abortion loomed larger in political debates, more opponents publicly attacked family planning. By 1972, President Nixon had changed his position by opposing family planning as part of the effort to win the vote of working-class Catholics from the Democratic party. Not all opponents, however, were conservative. Jesse Jackson, for example, was a vehement critic of abortion as were many Black Muslims who attacked family planning programs as a plot against the black community. In the final chapter, Critchlow sketches the legal attack that ensued against abortion and the reinvigoration of federal support under President Clinton. Importantly, Congress did not dismantle family planning policies even though it restricted federal funding of abortion. Although it is difficult, despite Critchlow's best efforts, to determine if family planning had the effect the policy network intended, it is clear that government-sponsored family planning was firmly entrenched. By 1973, 2.6 million women received planning services in public and private plans (p. 175). In 1997, the government spent over $700 million annually on contraception, sterilization, and abortion (p. 3). Even with limited federal funding, moreover, abortion survived as a constitutional right through the conservative revolution of the 1980s.
Intended Consequences makes many contributions to policy history. Besides providing a history of an unexplored topic, Critchlow shatters the artificial divide that exists between political, social, and cultural history. He shows that all three were an important component to a larger story. For example, Critchlow reveals how changes in national popular culture influenced this particular policy and how family planning involved a wide range of political actors, such as elected officials, foundations, medical officials, universities, and grass roots activists. All of these actors contributed at different points and in different ways to the development of this policy. Unlike much of most social scientists, Critchlow emphasizes the role of individuals in policy formation. Figures such as John Rockefeller III were essential to the success and failures of these policies. Critchlow's synthetic approach to policy history embodies the approach to scholarship that he has been calling for over the years.
Critchlow also integrates effectively electoral politics into policy history, something that many scholars have failed to accomplish. In one of the most important issues in the book, Critchlow shows how politicians constantly calculated the impact of these policies on the Catholic vote. Presidents Eisenhower, Kennedy, and Johnson (until 1967) simply would not risk losing this constituency. Had the Vatican changed its position in 1968, as some expected, the history of family planning might have been quite different. President Nixon, moreover, reversed his position in 1972 as part of a larger electoral strategy to capture working class voters.
Finally, Critchlow reveals what appears to be a common post-New Deal phenomenon, whereby policy agendas emerged in elite circles and only gradually filtered down to the grass-roots level. This process contradicts traditional narratives on political history. Critchlow echoes Brian Balogh's Chain Reaction, which presents a similar pattern in the politics of atomic energy. Family planning, which today is a heated grass-roots issue, actually started in the relatively closed world of policy elites.
While Critchlow makes many contributions through this book, one wishes that he extended his analysis of each stage in policy development after debates entered into a new phase. The book does not provide much information about how policies were implemented over long stretches of time or how they continued to expand even when political debate shifted to a new issue. For example, the book loses sight of family planning in international policy once Critchlow changes his focus to the post-1964 concern with domestic issues. Yet he provides clear evidence that family planning continued to be important internationally well into the 1990s. The book also loses sight of family planning in the domestic arena once Critchlow turns his attention to the politics of abortion after 1973. While debate shifted in each period, his evidence shows that the policies did not die. In some cases, the programs seem to have become even stronger when less attention was focused on them.
Neither does Critchlow delve much into the legislative side of this policy history even though he provides ample evidence that legislators were key sources of support and opposition to this policy. Legislators such as Bush and Ernest Gruening (D-Alaska) were responsible for promoting and shepherding policies through Congress even when presidents remained lukewarm in their support. In the 1970s, Henry Hyde (R-Illinois) spearheaded the attack on abortion. While the opposition within Congress is handled in more depth, we gain a less detailed understanding of why particular legislators (and their states and districts) championed family planning even when it seemed to be such a dangerous political issue. Examining Congress in greater depth would have furthered Critchlow's nuanced exploration of the complex relationship between popular attitudes and policy success.
Nonetheless, Critchlow's book is a major accomplishment. This is American policy history at its best. Not only does this book bring to light a previously unexamined component of policy history, but it also shows a constructive method of writing policy history that integrates social and cultural history while playing close attention to elites, institutions, and policy. In short, Intended Consequences is a must-read for all historians, whatever their discipline, and it is certain to contribute scholarly insights to some of today's fiercest political debates.
This review was commissioned for H-Pol by Lex Renda <firstname.lastname@example.org>
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