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 Simone M. Caron (Department of History, Wake Forest University.)
Published on H-Women (August, 1999)
Reproductive Policy in the Postwar Period
Donald Critchlow offers an insightful analysis of the development of federal policy regarding birth control and abortion since the early 1950s. Much of the responsibility for this policy came from the "population lobby" that emerged in the 1950s to argue that contraceptives could help ameliorate "an array of social problems, including poverty, welfare, crime, urban decay, and pollution" (p. 5). This lobby benefited from shared racial, religious, and socio-economic characteristics and from their access to policy makers not only in Congress and the White House, but at social clubs and private dinners. Interest groups were able to influence policy development by the 1960s because most Americans accepted the notion of family planning and thereby protected contraceptive programs from political attacks.
The book begins with a look at the burgeoning population movement in the early 1950s. While various organizations were working for population control, no clearly organized movement emerged until John D. Rockefeller III gave it structure. Rockefeller was "a pivotal figure in a movement that transformed American domestic and foreign population policy" (p. 14). He was a cautious man who endeavored to use scientific objectivity to shape public policy and was leery of assuming the "alarmist" rhetoric of prophets of doom such as Hugh Moore. The latter was willing to sacrifice individual rights in order to attain his ultimate goal of population control. In fact, Moore promoted coercive polices, should voluntary ones fail to bring about desired results. Rockefeller found Moore too radical and set out to convince the Rockefeller Foundation to assume a leadership role in the population movement. When this attempt failed, Rockefeller established the Population Council in 1952 specifically for the purpose of population control. The Council helped establish an international network of like-minded people with regard to a population agenda; to legitimize the burgeoning field of demography; and to initiate population programs in countries around the world.
By the early 1960s, the population movement directed its attention toward domestic policy. It inundated the public with articles and television shows about the threat of overpopulation. When Lyndon B. Johnson assumed the presidency, the population lobby worked hard to convince him to incorporate family planning in his War on Poverty. Johnson, however, worried about political reprisals from Catholics and blacks, both of whom traditionally voted Democrat. The Population Council and Planned Parenthood Federal of America (PPFA) persuaded Johnson to address the gravity of overpopulation in his State of the Union Address but failed to induce him to create a president's commission on population. He buried family planning within existing agencies, especially health and welfare programs, rather than establish a new centralized agency solely for contraception. The lack of an effective method of national distribution, exacerbated by the lack of nationalized health care, left the government dependent on private organizations for dispersal. With the prodding of the population lobby, "a policy revolution in federal family planning had occurred" by 1968 (p. 50). The simultaneous "cultural revolution" led to mainstream acceptance of birth control and eased the job of population activists in justifying programs that allowed equal access to birth control for poor and low-income women.
Richard M. Nixon was "more enthusiastic" than Johnson in supporting family planning. Nixon considered it a panacea to a host of problems ranging from poverty, out-of-wedlock births, and welfare. Still, he continued to rely heavily on private organizations for the delivery of services. Both the Ford Foundation and the Population Council moved from "policy research to policy implementation" in the late 1960s (p. 97). This working relationship between the government and the private sector did not always operate smoothly. The latter resented the bureaucratic red tape of government overseers. Moreover, government funds that had been promised to certain programs sometimes failed to materialize. This "painful" and often bitter arrangement led both the Ford Foundation and the Population Council to conclude that "active involvement in providing family planning services had detracted from their principal missions to provide basic medical and social science research" (p. 111). As a result, the government became much more heavily dependent on PPFA for distribution, and PPFA came under increased federal restrictions, particularly once abortion entered the formula.
During this ongoing policy revolution, the Catholic Church was in an awkward position. It supported the social welfare programs of the Great Society and the War on Poverty; it long desired to be accepted in American society; it endeavored to be seen as progressive, not regressive; it realized that Protestant and Jewish leaders had come out in support of birth control; and it could not in good faith participate in federal programs that involved family planning if the church deemed birth control immoral. Rockefeller worked to curry the favor of liberal Catholic theologians who could help loosen official Church opposition to birth control. Critchlow provides an excellent analysis of the nuances and intricacies of the behind-the-scenes wrangling among hardliners, liberals, and moderates within the Church leadership to devise an acceptable position for the Church with regard to federal funding of birth control. After five years of debate among experts chosen by Pope John XXIII in 1963, Pope Paul VI reissued the Church's aversion to "unnatural" means of birth control in 1968. Dissension in the American Catholic Church was immediate. By 1970, only fifteen percent of American priests expected their flock to adhere to the Pope's pronouncement. Publicly, American church leaders agreed not to opposed federal funding of birth control as long as all programs were voluntary, and they offered instruction about the rhythm method to church members.
The introduction of abortion reform brought major transformations to the population movement. While American Catholic leaders were willing to remain silent on birth control, the same was not true for abortion. Although the evolution of family planning policy came primarily as the result of the lobbying efforts of white elite males working within nonprofit organizations, abortion reform brought feminists and grassroots groups into the political debate. Family planning had remained a bipartisan issues throughout the 1960s, but abortion "shattered bipartisan support . . . and helped take population control off the presidential agenda" (p. 149). Abortion "polarized the general public, policy makers, and religious groups in a way that family planning never did", and it altered the debate from one of population control to one of rights--rights of the woman and rights of the fetus (p. 176).
This debate had a significant impact on Rockefeller. By 1974, he had done an about face on the issue of population control. Crucial to his reassessment was the appointment of Joan Dunlop as Rockefeller's associate in 1973. She offered a critique of the population movement's cure-all approach of population control as too narrow and simplistic because it ignored the cultural norms of various groups and it lacked any programs for economic development. Population controllers were willing to rest on the laurels of the pill, IUD, sterilization, and abortion rather than address the real social and economic problems of less developed countries. While Rockefeller respected and therefore adopted Dunlop's views, others employed red-baiting tactics to damage her reputation. Many of these men simply resented a female criticizing a population agenda that they had formulated.
Rockefeller spent the last five years of his life fighting to legalize and then protect legal abortions, and to emphasize the importance of sex education. He shifted his international concerns away from the single curative approach of contraception to adopt a larger agenda of social and economic reform, including health care, education, economic development and women's rights. This transformation came at the urging of his two daughters, his niece, and Dunlop, all of whom were avowed feminists. Because of them, Rockefeller rejected population control rhetoric to advocate abortion reform and instead based his support on the right of women to control their bodies. His new tact was not popular in his own Population Council. Many felt betrayed by his shift in focus. He searched for a new president for the organization who would reflect his new views and appoint more women to influential positions in the Council. On Dunlop's recommendation, George Zeidenstein assumed the presidency in 1975. The book shifts its focus after Rockefeller's death in a 1978 car accident, examining funding restrictions, presidential campaigns and the politics of abortion, and the growing violence of the antiabortion camp since the 1970s.
In the end, "the dreams and efforts of a select group of philanthropists, social scientists, population activists, and feminists transformed public policy in the United States. They achieved their intentions and welcomed with little reservation the consequences of their actions" (p. 224). They succeeded in reducing population growth internationally and domestically, although economic development and the women's rights movement helped in this reduction. From 1965 to 1974, activists transformed public policy to include family planning and abortion. Although these policies have faced restrictions, they were able to weather bombardments during the Republican presidencies of Ronald Reagan and George Bush. Nevertheless, activists failed to attain all their goals completely. They were not able to reach the number of targeted indigent or low-income women they had planned to with contraceptives. Family planning did not reduce poverty levels. Out-of-wedlock births did not decrease but instead increased. Abortion ended in "political stalemate: abortion remained a constitutional right, but Congress refused to support this right with federal funds" (p. 233).
Throughout the book, Critchlow adopted the terms "proabortion" and "antiabortion" because these terms seemed "more accurately descriptive of the policies actually pursued by the groups in question" (p. 12). One wonders, however, if people really are "proabortion," or do activists who support legal abortion do so in order to ensure that individual women have a full gamut of choices available to them to control their reproduction? Finding terms that are not politically loaded is difficult but proabortion is not one that many prochoice activists would accept to label themselves. There is also some confusion over how important the issue of rights was to the reformation in policy. Critchlow argues that "while advocacy of contraception as a mechanism for liberating women from the arbitrary controls of a male-dominated society remained an important source for federal family planning", he later contends that advocates for federal involvement in family planning downplayed any rights issues and stressed instead overpopulation, welfare savings, and the reduction of out-of-wedlock births (p. 3). Rights did not enter the picture until the abortion debate began. In fact, Critchlow claims that the only large organization concerned more with "the rights of women and families to control reproduction" (p. 15) than with population control was PPFA. Yet in 1951, William Vogt, the author of Road to Survival (1948), became director of PPFA. His book was one of the most influential neo-Malthusian arguments in the postwar period. Vogt believed "a population crisis was imminent" (p. 31), and he worked closely with Moore, the radical "alarmist" who was willing to forego individual rights to attain his ultimate goal of population control. Was his appointment a strategic move on the part of PPFA to appeal to the funding available from population controllers, or did his views reflect the beliefs of PPFA leaders?
Other sections of the book would benefit from additional commentary by Critchlow. Well into the late 1960s, for example, the Population Council continued to rely on IUDs in overseas programs because they were "cheap" and "placed less responsibility on the user" (p. 28). What Critchlow does not mention is the implicit belief of population controllers that low-income women were not capable of assuming responsibility for other methods. He also does not point out that the IUD left women completely dependent on physicians for removal. If health care providers were unavailable or unwilling to remove it, women could not choose to become pregnant. Critchlow goes on to praise Clarence Gamble's research programs in Puerto Rico, but does not note the abuses women there suffered at the hands of population controllers, in particular uninformed sterilization procedures and experimental contraceptive programs that virtually turned many Puerto Rican women in to human guinea pigs. Critchlow also applauds the research of Gregory Pincus, again in Puerto Rico, but fails to comment on the class and racial implications of population "experts" experimenting on indigent and low-income women of color.
Other sections of the book are somewhat unclear. Critchlow offers a puzzling account of a Baltimore contraceptive program "targeted at Baltimore's inner-city black teenage female population." Yet he then states that the "program focused on the racially mixed area of west Baltimore" and that "most of the white teenagers dropped out for unexplained reasons." Of the remaining blacks, "most only appeared once and then dropped out" (p. 105). He does admit that the program was a failure but just who was targeted is unclear. A program directed only at black teens would have caused an uproar in a political climate already charged with cries of genocide. In another part, the author contends that population activists "brought to the policy arena well-intentioned concerns about how to make America a better society and the world a better place" (p. 9). Yet he later admits that many activists were not concerned about women per se, or about the economic development of the poor both at home and abroad. Perhaps their well-intentions were to make the world a better place for white elites by reducing the consumption of world resources by the perceived over breeding of the underclass. In fact, Critchlow points out that early Population Council drafts demonstrated a eugenic strain reminiscent of programs under Adolf Hitler; by the late 1950s, some in the Council believed that once population growth was under control, the Council could begin work on population quality.
Two other minor questions remain unanswered. First, the campaign launched by population activists to inundate the public with articles concerning overpopulation was disproportionately targeted at women. Between 1959 to 1974, women's magazines carried a plethora of alarmist stories but only one such article appeared in men's magazines. Because this deluge was a "concerted public relations campaign" by the population movement, one wonders why women and not men were the center of the campaign (p. 54). Second, Critchlow posits that mainstream society accepted family planning by the late 1960s. Yet two of the most public supporters of federal involvement in this area, Ernest Gruening and Joseph Tydings, lost their reelection bids for the U.S. Senate. Was their defeat tied to contraceptive programs or were other issues involved?
The book ends with a discussion of sexuality, including homosexuality. Critchlow argues that while "Americans generally disapproved of homosexuality, . . .this attitude was clearly changing." He supports this assertion with the results of two polls. In 1973, "close to 80 percent" answered that homosexuality was wrong, while in 1997, "the trend was toward acceptance of homosexuality" because "71.9 percent" believed it was wrong (p. 237). With the height of the gay rights movement taking place during this period, especially the inclusion of sexual orientation protection in some state and local laws and in private work-place policies, one would expect the change to be much larger. Over a twenty-five year period, the percentage disapproving only dropped by seven percent. This statistic does not support a clear change in attitudes toward the acceptance of homosexuality.
These points aside, Critchlow offers a very valuable contribution to the literature on reproductive policy in the postwar era. His analysis of the role of individual philanthropists in the quest to reform policy is noteworthy. Of particular importance is his detailed examination of the various stages of policy implementation on the federal level since the 1960s. His book is a must-read for historians and political scientists alike who are interested in the complex policy developments that take place in the federal government.
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Simone M. Caron. Review of Critchlow, Donald T., Intended Consequences: Birth Control, Abortion, and the Federal Government in Modern America.
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