Reconceived: Women’s Reproduction after Roe v. Wade

By Sara Matthiesen

B.A., University of California Santa Barbara, 2008 A.M., Brown University, 2011

A dissertation submitted in partial fulfillment of the

Requirements for the degree of Doctor of Philosophy

In the Department of American Studies at Brown University

Providence, Rhode Island

May 2016

© Copyright Sara Matthiesen 2016

iii

This dissertation by Sara Matthiesen is accepted in its present form

by the Department of American Studies as satisfying the

dissertation requirement for the degree of Doctor of Philosophy.

Date___________ ____________________________

Tricia Rose, Advisor

Recommended to the Graduate Council

Date___________ ____________________________

Robert O. Self, Reader Date___________ ____________________________

Laura Briggs, Reader

Approved by the Graduate Council

Date___________ ____________________________

Peter Weber, Dean of the Graduate School

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CURRICULUM VITAE

Sara Matthiesen received her Bachelor of Arts from the University of California, Santa

Barbara in 2008. She entered the graduate program in American Studies in 2009, earning

a Master’s Degree in 2011. She was raised in the San Francisco Bay Area.

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ACKNOWLEDGEMENTS

My dissertation often felt stubbornly difficult to visualize, but many people along the way

had faith in my vision. I am grateful to them for being there when my own faith faltered.

My dissertation chair Tricia Rose not only inspired me as she does so many, but she also

helped me cultivate my voice at a critical moment in my graduate career. I continue to

speak with confidence and conviction in large part because of her. Robert O. Self

encouraged me to challenge my scholarly and political biases my first semester of

graduate school, and six years later I am a better scholar because of him. Laura Briggs

saw potential in the project even though she did not have to, and generously mentored me

and guided my scholarly thinking from afar. Should I continue my academic career, I

take absolute comfort in knowing that my own mentoring and advising will be comprised

of what I have learned from these three amazing scholars. Gail Cohee not only offered

me a job that was a welcome reprieve from the dissertation, but also showed me how to

be a scholar and mentor committed to social justice; I am indebted to her for all she

taught me over the years.

While the dissertation loomed large throughout my time in Providence, RI, my

friendships—both near and far—always held their own against the demands of work, and

I am grateful for the balance these individuals brought to my life over the years. Colleen

Tripp and Pier Dominguez lessened the blow of my cross-country move to New England

with their warmth, humor, and willingness to become fast friends. Elizabeth Searcy, John

Rosenberg, Brooke Lamperd, Sam Franklin, and Oddny Helgadottir loved me

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unconditionally and happily joined me on many a RI adventure, giving me some of my

fondest memories of the past six years. Majida Kargbo, Lindsay Goss, and Kate Diedrick

inspired me with their strength and sustained me more than they know; their commitment

to justice and the brilliant passion with which they fight for what they believe in has

taught me more than any book. Jessica Johnson and Sasha Berkoff made our apartment a

wonderful place to call home, and their respective insights during our many

conversations taught me a lot. I admire how genuinely each of them engages the world,

and their friendship has encouraged me to follow suit. Elizabeth Wolfson, Robyn

Schroeder, and Sarah Brown caught me off guard with their incredibly refreshing

openness later in my career, when I foolishly thought I was done making friends. In their

own ways, each of them has taught me to be more self-possessed, and, along with Majida

Kargbo, has offered some of the most hilarious commiseration I have ever had the

pleasure of being a part. I also found Dan Platt and Anne Gray Fischer late in grad

school. It is rare that intellectual and political interests align, but I often find this in my

friendship with the two of them. Anne has especially been a source of both unconditional

support and exciting ideas, and I am so glad to call her my friend.

Alyise Temores believed in me before I ever moved across the country, and has

continued to be my biggest fan. In spite of the distance between us, she continues to

ground me in all manner of things, as only someone with Alyise’s wit can, and her and

her beautiful family always make me feel like I am home. It feels like I have shared many

phases of life with Peggy Lee, which means I have benefitted from her wisdom for a long

time. Peggy always seems to see something in me that I forget or don’t know is there, and

I am a stronger, fiercer woman because of her. Bryan Fauth has always welcomed me

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home with open arms, no matter how long it is has been since we last saw each other. I

could not ask for a better, truer soulmate. Alvaro Bernal seems to live on my wavelength,

and there are few people who time spent with is both so easy and restorative; I feel lucky

to have such a smart and curious Twinsy. Cari Ham has known me longer than anyone,

and has been a constant in my life. She is a force to be reckoned with in all things, and

our friendship has been no exception. I am indebted to her for the many law articles and

court cases she translated for me, and for her pride in my decision to get a PhD. I look

forward to the day when these people are as close to me geographically as they are to my

heart.

My family has always offered unwavering and unconditional support, and the

same has been true for my decision to go to graduate school. Leaving them was the

hardest thing about moving across the country, and I am grateful that they have never

once begrudged me for doing so. Even from so far away, my mom Martha, dad Marty,

and brother Nick have offered respite, reassurance, and love at every turn. I know they

never really asked for anything in return for always believing in me, but my dissertation

is dedicated to them.

I found Ben Holtzman near the beginning of my time in RI, and we have been at

each other’s side ever since. More so than anyone, Ben’s faith in me was constant when

my own was far less reliable. His thoughtfulness, honesty, and conviction makes our

conversations one of my favorite things, and his approach to leisurely adventure, so

different from my own, has made life far more fun. Our time together has taught me that

growth can be incredibly fulfilling. For making me unafraid, I thank Ben.

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TABLE OF CONTENTS

Curriculum Vitae iv Acknowledgments v Table of Contents viii Introduction 1 Chapter One: From a “World Federation of Emergency Pregnancy Services” to “Bogus Clinics,” 1970-1990 17 Chapter Two: Navigating “Risk”: Women, AIDS, and the Politics of Reproduction, 1980-1995 60

Chapter Three: “Prisoner-Mothers” and the Politics of Women’s Incarceration and Rehabilitation, 1970-1990 99 Chapter Four: Fertile Ground, 1990-2010 166

Conclusion 207 Bibliography 211

1

INTRODUCTION

Reconceived: Women’s Reproduction after Roe v. Wade

In a black and white photo taken at an abortion rights rally in the late 1960s, a

young, white women’s liberationist is pictured holding a sign that reads, “Pregnancy is

not Motherhood.”1 While the movement to legalize abortion during the last third of the

20th century involved a coalition of advocates with diverse investments, those motivated

by women’s equality spoke most forcefully and publicly about the necessity of abortion

for ensuring women’s bodily autonomy.2 Abortion rights activists made the link between

reproductive control and women’s liberation central to the abortion debate by arguing

that appeals to population control and reproductive health were “only embroidery on the

basic fabric: woman’s right to limit her own reproduction.”3 At the same time, grass roots

and legal organizing against the forced sterilization of women of color challenged a

definition of control based solely on limiting reproduction.4 In her seminal essay “Double

Jeopardy,” Frances Beale explained how full reproductive control depended on freedom

1 I came across this picture while looking at Duke’s digital archives on the women’s liberation movement one day. When I went back for it, it was nowhere to be found. I am currently working with one of the archivists to try to track it down for proper citation information. 2 For an overview of the different investments in legalizing abortion, see Kristin Luker, Abortion and the Politics of Motherhood, Berkeley, University of California Press, 1984. For a discussion of how women’s advocates came to be the authority on the necessity of legalized abortion see Robert O. Self, All in the Family, Hill and Wang, 2013, p. 137-148. 3 Lucinda Cisler, “Unfinished Business: Birth Control and Women’s Liberation,” in Sisterhood is Powerful, ed. Robin Morgan, New York, Vintage, 1970, p. 277-278. Quoted in Rosalind Petchesky, Abortion and Woman’s Choice: The State, Sexuality, and Reproductive Freedom, Northeastern University Press, 2nd Edition, 1990, p. 126. 4 See Rebecca Kluchin, Fit to Be Tied: Sterilization and Reproductive Rights in America, 1950-1980, New Jersey, Rutgers University Press, 2009, p.148-213.

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from coercive regulation as well as the ability to prevent pregnancy. “The lack of

availability of safe birth control methods, the forced sterilization practices, and the

inability to obtain legal abortions are all symptoms of a decadent society that jeopardizes

the health of black women (and thereby the entire black race) in its attempts to control the

very life processes of human beings.”5 Black and Chicana women best articulated a

capacious vision of reproductive control that included childbirth alongside sex for

pleasure.6

Yet despite the fact that a broad framework of reproductive control encompassed

both the right to prevent pregnancy and the right to have children, only abortion

necessitated—and made a reality—the women’s liberationist’s declaration “pregnancy is

not motherhood.” While birth control necessarily disconnected sex from procreation,

abortion represented a far more troubling disconnect—pregnancy would no longer be

attached to motherhood. Demanding the right to abortion entailed understanding

pregnancy anew, an understanding that did not automatically invoke childbirth. The

successful mobilization for abortion rights did more than usher in Roe v. Wade. It also

gave pregnancy a new legal, political, and cultural meaning. In a post-Roe era, pregnancy

no longer meant motherhood. Since 1973, bringing a pregnancy to term has constituted a

choice.

Of course, “choice,” despite implying multiple possible outcomes, immediately

invokes only one: abortion. This discursive strategy forged by major abortion rights

organizations during the fight for legalization is arguably the pro-choice movement’s

5 Frances Beal, “Double Jeopardy: To Be Black and Female,” in Words of Fire: An Anthology of African American Feminist Thought, ed. by Beverly Guy-Sheftall, New York, The New Press, 1995, p. 146-155. 6 See Jennifer Nelson, Women of Color and the Reproductive Rights Movement, NYU Press, 2003; Angela Davis, “Racism, Birth Control, and Reproductive Rights,” in From Abortion to Reproductive Freedom: Transforming a Movement,” ed. by Marlene Gerber Fried, Boston, South End Press, 1990, p. 15-26.

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most enduring legacy. Yet the reach of choice has been greater than is often realized. The

near automatic association of choice with abortion has obscured the fact that when

pregnancy was redefined during the fight for legal abortion, so too was motherhood.

Indeed, one of the insights offered by Reconceived: Women’s Reproduction after Roe v.

Wade is the fact that in a post-Roe era, motherhood has overwhelmingly been

reconceptualized as a choice. Redefining pregnancy via abortion necessarily entailed

redefining motherhood, but this effect is rarely articulated.7 Instead, motherhood has

remained attached to the dominant narrative of family planning, whereby women and

couples wait until they are “ready”—emotionally, financially, professionally—to have a

child, presumably aided by birth control, not abortion. As pro-choice organizations are

quick to point out, this narrative is a myth for poor women, young women, and Black,

Native American, and Latina women who disproportionately experience unplanned

pregnancy and single motherhood because they lack access to contraception, sex

education, and abortion services. But even this counterpoint, while a far more accurate

depiction of reality, reinforces the definition of pregnancy as a choice to prevent or

terminate the possibility of motherhood.

Reconceived aims to make visible the ways expectations of choice and family

planning—women’s ability to limit their reproduction—came to bear on pregnancy and

motherhood in a post-Roe era. These expectations have significant social and political

implications for the lived experience of motherhood because the promise of choice falls

short for the vast majority of women. The same structural constraints that comprise the

7 Rickie Solinger’s study of abortion, adoption, and welfare post-Roe is an important exception. Solinger argues that the politics of choice surrounding abortion further constituted motherhood as a class privilege in the U.S., making consumer logic the dominant mode of thinking about motherhood. Rick Solinger, Beggars and Choosers: How the Politics of Choice Shapes Adoption, Abortion, and Welfare in the United States, New York, Hill and Wang, 2001.

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realities of birth control and abortion access—or lack thereof—make up the realities of

pregnancy and motherhood. Just as it is easier to access contraception and abortion if one

is white, has sufficient disposable income, a flexible work schedule, private health

insurance, and lives in or near a city, so too is it easier to raise a child. Yet because

motherhood is not only chosen but also planned for, having a child is subject to even

greater implicit expectations about what being “ready” means. In the post-Roe landscape,

being “ready” means being prepared for the fact that the social, economic, and

professional costs of pregnancy and motherhood will be borne individually; that is the

reality incurred by choice. While scholars have shown how a framework of choice elides

the multiple barriers that keep abortion out of reach for the vast majority of women, I

argue that it has also further entrenched the idea that pregnancy and motherhood are

individual burdens women must resolve privately.8

Reconceived illustrates these claims through an examination of struggles over

reproduction that pivoted on supporting women’s pro-creative capacities, not through

birth control and abortion, but through accommodations and services that accounted for

women’s needs as pregnant people and mothers: in other words, battles that exposed the

ways motherhood and its attendant realities had not been resolved by choice. 8 The critique of choice is often tied to the fact that the legal framework that won Roe was the right to privacy. As such, Roe ensured that the state would not keep women from obtaining an abortion, but it would also do nothing to ensure women’s access to the procedure. Abortion was won as a negative rather than a positive right. For a thorough discussion of the limitations of the right to privacy see Rhonda Copelon, “From Privacy to Autonomy: The Conditions for Sexual and Reproductive Freedom,” in From Abortion to Reproductive Freedom: Transforming a Movement, ed. by Marlene Gerber Fried, Boston, South End Press, 1990. For a broader discussion of negative vs. positive liberty in relation to reproductive freedom see Dorothy Roberts, Killing the Black Body: Race, Reproduction, and the Meaning of Liberty, New York, Vintage Books, 1999, p. 294-312. Scholars have also shown how choice ensured abortion would be subject to market forces, available only to those with sufficient resources. See Solinger, Beggars and Choosers, p. 6-8; Self, All in the Family, p. 159-160; Petchesky, p. 6-8. In the introduction to From Abortion to Reproductive Freedom, scholar and activist Marlene Gerber Fried summed up the numerous failings of choice by asking of the recent mobilization for abortion rights, “But for what—freedom of choice circumscribed by race and class, removed from feminist demands about women’s autonomy, and shrouded in ‘privacy’?” p. ix.

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Reconceived does this by approaching three major political issues from the perspective of

advocates who foregrounded pregnancy and motherhood in their activism during the

1970s, 1980s, and 1990s. As a result, it recasts both the early years of the AIDS epidemic

and the shifting contours of crime and punishment during the 1970s and 1980s as sites of

reproductive struggle. At the same time, it revisits the abortion debate from the

perspective of pro-life women who considered legal abortion evidence of the state’s

abandonment of pregnant women and saw social service provision as the only way to

make abortion obsolete.

This diverse group of women of color and lesbian AIDS activists, largely white,

feminist prison reformers and prisoners’ rights advocates, and white, middle-class,

conservative “pro-life counselors” found themselves up against not only the social and

political circumstances to which they were opposed, but also the male-dominated

movements of which they were a part. Despite their vastly different political orientations

and social values, these advocates insisted that an alternative approach to the respective

issues of AIDS, incarceration, and legal abortion was required to adequately serve

women most affected. By and large, these alternative approaches—which produced

wholly distinct arms of the various movements of which advocates were a part—centered

on acknowledging and supporting women’s procreative capacity, whether that be the

potential for pregnancy, actual pregnancy, or motherhood. In their efforts to foreground

women’s needs within broader movements for change, they returned repeatedly to the

ways the reproductive aspects of women’s lives exacerbated the challenges wrought by

disease, incarceration, poverty, racism, and sexism.

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In most cases, advocates did not share the circumstances of the women they

worked on behalf of; by and large, Reconceived is not a story of self-advocacy. As such,

some advocates were better than others at making sure their advocacy was guided by

women who were most impacted. AIDS activists who worked on tailoring social service

supports for women, for example, insisted that such efforts be thoroughly informed by

the voices and experiences of HIV-positive women of color. In contrast, prison reform

advocates prioritized incarcerated women’s maternal suffering despite the fact that

women in prison identified a variety of challenges that exacerbated their experiences of

criminalization and confinement. Pro-life advocates who set out to provide social services

to women facing unplanned pregnancies were most constrained by their ideological

commitment to compulsory motherhood. This is not to say that the advocacy explored

here was irrelevant to women’s lives; supports for pregnant women and mothers were

absent from the institutions and practices advocates hoped to change and from the

broader movement agendas of which they were a part. But such efforts were always

informed by advocates’ worldviews, and as such they had mixed results for the women

they intended to serve.

By exploring these seemingly disparate modes of advocacy alongside one

another, I aim to illustrate the necessity of looking for activism at the intersections of

political and social issues rather than within explicit political designations, such as the

left or the right, identities, such as feminist or queer, or even established movement

frameworks, such as reproductive rights. This is especially important for scholars

interested in finding histories of political mobilization from the recent past that, while

very much motivated by either feminist, intersectional, or gendered analysis, were not

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explicitly organized under any such banners. The advocates in this story brought diverse,

often conflicting versions of a woman-centered analysis to causes not particularly

concerned with women’s or gender equality but forged in response to injustices of other

kinds. As a result, their analyses of the issues and the demands they placed on institutions

differed not only from many of those working in the same movement but often diverged

from co-occurring efforts explicitly identified as furthering “women’s rights” as well.

This approach, however, also presents challenges. While united by their focus on

the realities of pregnancy and motherhood, the struggles examined here differ in

important ways. The demands articulated by advocates took place in various institutional

and political contexts, and were motivated by different evaluations of what women truly

needed from society. The philosophy of pro-life advocates whose support of pregnant

women is driven by what might be most accurately described as coercive pro-natalism

has been especially vexing to reconcile with the other struggles taken up in Reconceived.

As a result of these differences, the outcomes of these debates do not necessarily result in

a singular insight. Instead, Reconceived relies on two, related analytical frameworks in an

effort to highlight the different significances these battles hold for scholarship concerned

with reproductive politics. The first framework aims to make visible the ways the myth of

choice affects women’s procreative capacity and motherhood. The second involves

foregrounding the ways state institutions refused to see pregnancy and motherhood as

qualities of citizenship, and instead relegated these aspects of reproduction to the private

realm of individual responsibility.

One way of getting at the first point is by asking: how the physical and legal

possibility of deferring motherhood, either through birth control or abortion, enabled or

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constrained institutional responses to the reproductive demands associated with

pregnancy and motherhood. Sometimes choice as the “solution” to reproduction directly

stymied the efforts of advocates. For example, in the case of AIDS activism and attempts

to gain women access to experimental drug trials, AIDS advocates as well as women’s

health advocates had to overcome the notion that women made for difficult research

subjects because of their procreative capacity. While women’s health advocates tried to

undo this notion by emphasizing the ways women’s reproduction could be controlled in

studies, women and AIDS advocates argued that experimental drug trials should be

redesigned in order to accommodate reproduction. The 1993 FDA decision to allow

women to participate in clinical trials as long as they agreed to use birth control is largely

considered a win for women’s rights by scholarship on women’s health and AIDS

activism respectively.9 However, I argue that this access was contingent on women

becoming non-procreative subjects and assuming responsibility for the reproductive risk

inherent in experimental drug testing.

In the case of pro-life service provision, however, pro-life advocates benefitted

from the dominance of the choice framework. As the abortion debate intensified due to

growing anti-abortion violence in the late 1970s and 1980s, pro-choice activists depicted

pro-life crisis pregnancy centers as part of the radical fringe element of the pro-life

movement known for its confrontational and sometimes violent tactics. Scholarship on

the abortion debate during this period has also framed pro-life centers as further evidence

9 See Carol Weisman, Women’s Health Care: Activist Traditions and Institutional Change, John Hopkins University Press, 1998, p. 81-88; Steven Epstein, Impure Science: AIDS, Activism, and the Politics of Knowledge, Berkeley, CA, University of California Press, 1996, p. 339; Steven Epstein, Inclusion: The Politics of Difference in Medical Research, Chicago, University of Chicago Press, 2007, p. 55.

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of the turn to more confrontational tactics during this period.10 As a result, the longer

history and distinct philosophy of pro-life centers was overlooked, as were the women

who had sought out centers not for abortions, but for help bringing their pregnancies to

term. This misidentification has ensured that crisis pregnancy centers continue to be seen

as a threat to choice, when in reality they are most likely to provide limited but needed

services to pregnant women and mothers.

The second framework, the disavowal and neglect of reproduction by state

institutions, is motivated by a desire to rethink the barriers to meaningful reproductive

freedom. Inherent in the demand that women be allowed to control their reproduction is

the accusation that some force has actively robbed them of that right. Scholarship on

women’s reproduction in the U.S. has thoroughly and powerfully documented the ways

in which women’s reproduction has been subject to control and intervention. Scholars

have identified the eugenicist, nativist, and imperialist motives behind public and private,

institutional and individual efforts to regulate women’s sexual freedom and reproductive

outcomes.11 Those examining the specific effects of legalized abortion in fomenting

conservative opposition to reproductive rights have also understood such efforts as being

motivated by a desire to preserve traditional gender roles and the nuclear family in the 10 See Faye Ginsburg, Contested Lives, Berkeley, University of California Press, 1998, p 119-121; Dallas Blanchard, The Anti-Abortion Movement and the Rise of the Religious Right, New York, Macmillan Press, 1994, Ch. 7; Suzanne Staggenborg, The Pro-Choice Movement: Organization and Activism in the Abortion Conflict, New York, Oxford University Press, 1991, p. 129-130. 11 Elena R. Gutiérrez, Fertile Matters: The Politics of Mexican-origin Women’s Reproduction (Texas University Press: 2008); Rebecca Kluchin, Fit to Be Tied: Sterilization and Reproductive Rights in America, 1950-1980 (New Brunswick: Rutgers University Press, 2009); Johanna Schoen, Choice and Coercion: Birth Control, Sterilization, and Abortion in Public Health and Welfare (Chapel Hill: University of North Carolina Press, 2005); Laura Briggs, Reproducing Empire: Race, Sex, and Science in Puerto Rico (Berkeley: University of California Press, 2003).; Marie Jenkins Schwartz, Birthing a Slave: Motherhood and Medicine in the Antebellum South (Cambridge: Harvard University Press, 2010); Dorothy Roberts, Killing the Black Body: Race, Reproduction, and, Liberty (New York: Vintage Books, 1997); Jeanne Flavin, Our Bodies, Our Crimes: The Policing of Women’s Reproduction in America, NYU Press, 2009; Alexandra Minna Stern, Eugenic Nation: Faults and Frontiers of Better Breeding in Modern America, University of California Press, 2005, 150-210.

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face of increased rights for women.12 A defining characteristic of this regulatory

framework is the emphasis on punitive moves that violate or constrain women’s

reproductive autonomy in an effort to maintain social hierarchies of race, class, gender,

and nation. The power of this tactic lies in the ways reproduction—and the attendant

categories of family and sexuality—can be used to mobilize support for or opposition to

various political agendas and ideologies far broader than individual women or even

groups of women themselves.13 Everything from anti-immigrant sentiment to fears about

overpopulation to gains for women in the workplace to economic policy intent on state

austerity can find expression in demands that fall on women’s bodies in differential,

stratified, and punitive ways.14

Yet one of the defining ways women’s reproduction was constrained in

Reconceived was not by deliberate efforts to control or regulate, but by a widespread

institutional refusal to see pregnancy and motherhood as qualities of citizenship. Here,

Reconceived builds upon scholarship exploring how the liberal state has constituted the

ideal citizen as a white, heterosexual, male, breadwinner whose status is further rewarded

and reinforced through access to home ownership, marriage, and government

12 The book that makes this argument specifically about the New Right is Petchesky’s Abortion and Woman’s Choice, p. 241-285. See also Linda Gordon, “Who is Frightened of Reproductive Freedom for Women and Why? Some Historical Answers,” Frontiers: A Journal of Women’s Studies, Vol. 9, No. 1, 1986, p. 22-26. For examinations of the ways the ascendance of the fetus has been instrumental in constraining women’s reproductive rights see Rachel Roth, Making Women Pay: The Hidden Cost of Fetal Rights (Ithaca: Cornell University Press, 2003); Janelle Taylor, The Public Life of the Fetal Sonogram: Technology, Consumption, and the Politics of Reproduction, (New Jersey: Rutgers University Press, 2008); Sara Dubow, Ourselves Unborn: A History of the Fetus in Modern America, (New York: Oxford University Press, 2011), p. 112-183. 13 In their introduction to Conceiving the New World Order, Rayna Rapp and Faye Ginsburg refer to the discursive exclusion of women from social practices or political agendas that will directly impact their reproductive autonomy as “euphemized violence.” See Rapp and Ginsburg Eds. Conceiving the New World Order: The Global Politics of Reproduction, Berkeley, University of California Press, 1995, p. 3-4. 14 Rapp and Ginsburg summarize Shelle Colen’s term “stratified reproduction” as “the power relations by which some categories of people are empowered to nurture and reproduce, while others are disempowered,” Rapp and Ginsburg, Conceiving the New World Order, p. 3.

11

entitlements.15 This version of citizenship has stubbornly resisted rights claims aimed at

expanding the definition of the ideal citizen. Instead, citizenship has opened its doors to

women, minorities, and gays and lesbians so long as these groups resolve their various

differences privately.16 Reconceived approaches battles over reproduction with an eye

towards the ways state infrastructures kept pregnancy and reproduction outside the

bounds of citizenship and instead insisted on a practice of reproductive neglect.

The battles in Reconceived illustrate this refusal to expand the bounds of

citizenship in two ways. The first and arguably more straightforward examples are those

in which institutions were directly confronted with women’s reproduction but refused to

adjust institutional structures to better accommodate pregnancy and motherhood. Such

examples offer evidence that the liberal state continued to see pregnancy and motherhood

as beyond the purview of citizenship in a post-Roe era. Advocacy around women’s

incarceration is particularly illustrative of the ways that prisons and jails largely refused

advocates’ and prisoners’ demands that corrections change its practices to allow women

to mother during their imprisonment. When confronted with an influx of female prisoners

in the 1980s and 1990s, correctional institutions chose to continue operating as if the

15 See Margot Canady, The Straight State: Sexuality and Citizenship in Twentieth Century America, Princeton University Press, 2009; Elizabeth Cohen, A Consumer’s Republic: The Politics of Mass Consumption in Postwar America, New York, Vintage Books, 2003; Linda Gordon; Pitied but Not Entitled: Single Mothers and the History of Welfare 1890-1935, New York, The Free Press, 1994; Linda Kerber, No Constitutional Right to be Ladies: Women and the Obligations of Citizenship, New York, Hill and Wang, 1998; Mae Ngai, Impossible Subjects: Illegal Aliens and the Making of Modern America, Princeton, Princeton University Press, 2003; Robert O. Self, American Babylon: Race and the Struggle for Postwar Oakland, Princeton, Princeton University Press, 2005; Lauren Berlant, The Queen of American Goes to Washington City: Essays on Sex and Citizenship, Durham, Duke University Press, 1997; Dona Hamilton and Charles V. Hamilton; The Dual Agenda: Race and Social Welfare Polices of Civil Rights Organizations, New York, Columbia University Press, 1997; Alice Kessler-Harris, In Pursuit of Equity: Women, Men, and the Quest for Economic Citizenship in 20th-Century America, New York, Oxford University Press, 2001; Nancy Cott, Public Vows: A History of Marriage and the Nation, Cambridge, Harvard University Press, 2002; Thomas Sugrue, Origins of the Urban Crisis: Race and Inequality in Postwar Detroit, Princeton, Princeton University Press, 1998. 16 See Robert O. Self, All in the Family.

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default prisoner was male in spite of advocates’ best efforts to gender corrections.17 The

effort to include female subjects in clinical AIDS trials also offers an example of how

state institutions, in this case the FDA, refused to accommodate women’s procreative

capacity beyond the requirement that it be controlled.

In addition to tracing the processes by which pregnancy and motherhood were

excluded from institutional structures of citizenship, Reconceived also asks what making

relegating these aspects of life to the private sphere has made possible.18 For example, I

argue that we should see the expansion of pro-life crisis pregnancy centers in the context

of widespread state retrenchment that severely weakened social programs for poor and

low-income people. The resource gap left by the state’s disavowal of the welfare of some

of its citizens, including poor mothers and children, created an opportunity for pro-lifers

to become embedded in a network of public and private services for pregnant women. As

a result, women in need of resources are far more likely to obtain the limited and

ideologically driven aid of crisis pregnancy centers than women who resolve (and fund)

motherhood on their own.

Through varied case studies, Reconceived shows how women’s advocates not

only had to fight against choice as a dominant frame for understanding reproductive

rights, but also had to fight for institutional acknowledgement of pregnancy and

motherhood. Reconceived offers a vantage point whereby these processes are made 17 This is arguably the case for sentencing reforms that were explicitly made “gender neutral” as well, and an area of interest for future research. 18 We might call this configuration the “privatization of motherhood.” In her discussion of reproductive technologies, Dorothy Roberts argues that the reproduction of both poor women of color and wealthy white women is regulated through the respective processes of punishment and privatization. For Roberts, this dual system of regulation is used to “shift responsibility for improving social conditions away from the state.” The privatization of motherhood is narrower in scope, but follows the logic offered by Roberts in that women rather than the state are exclusively responsible for the realities of pregnancy and motherhood. See Dorothy Roberts, “Privatization and Punishment in the New Age of Reprogenetics,” Emory Law Journal, Vol. 54, 2005, p. 1343-1359.

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visible. The struggles in Reconceived are decidedly not stories of triumph for women’s

reproductive freedom. They are, however, an illustration of how the logic of reproduction

as a uniquely gendered burden became further entrenched in the post-Roe era. While this

entrenchment often happened quietly, through neglect rather than force, the effects are

just as harmful as reproductive rights violations deliberately aimed at control. Revealing

the processes by which this happened has the potential to change how we think about

barriers to reproductive freedom and will perhaps enable us to see reproduction as a

public good rather than a private burden borne by some bodies over others.

Reconceived consists of four chapters, beginning and ending with the abortion

debate. This organizational choice runs the risk of centering a debate that has a long

history of obscuring equally pressing reproductive rights issues. However, the reframing

offered in both chapters shows how the structural realities of motherhood emerge when

abortion is de-centered, even in the context of the abortion debate itself. Chapter one,

“From a World Federation of Emergency Pregnancy Services to ‘Bogus Clinics,’ 1970-

1990,” details the origins of current day crisis pregnancy centers. Begun in 1971 in

response to liberalized state abortion laws, the founders of Alternatives to Abortion

International enacted a social service response to legal abortion. Long before the pro-life

movement turned to a woman-centered strategy in the mid-1980s, those committed to

emergency pregnancy services argued for a response to abortion that accounted equally

for the woman and the unborn. In the 1980s and early 1990s a series of lawsuits claiming

damages for deceptive advertising would bring these clinics national attention while

obscuring the long-term success of their woman-centered strategy. I trace how pro-choice

organizations misidentified centers as another component of the anti-abortion violence

14

taken up by a radical fringe of the pro-life movement. As a result, the ways centers

provided limited but needed services to the women were lost on those committed to

abortion rights.

Chapter two, “Navigating ‘Risk’: Women, AIDS, and the Politics of

Reproduction, 1980-1995,” examines the efforts of women and AIDS advocates to ensure

that municipal and federal level responses to the epidemic accounted for women’s

reproductive needs. The first part of the chapter chronicles early women and AIDS

projects founded in New York City and San Francisco. These projects insisted that HIV-

positive women of color needed unique services that took into account their familial

responsibilities, and in New York City such efforts resulted in the first residential center

for HIV-positive women of color in the country. The second half of the chapter revisits

the more widely documented battle between women and AIDS advocates involved in the

direct action AIDS movement and the Food and Drug Administration (FDA). I show how

the specific demands of these women have been subsumed in subsequent studies

concerned with AIDS activism on the one hand and women’s health activism on the

other. Ultimately, I reframe the debate to show how the FDA’s decision to lift the ban on

women’s participation in clinical drug trials was influenced by the logic of choice that

resolved the “problem” of women’s reproduction with prevention.

Chapter three, “‘Prisoner-Mothers’ and the Politics of Women’s Incarceration and

Rehabilitation, 1970-1990,” begins with the emergence of feminist concern about the

“female offender” in the early 1970s and traces how advocates for women in prison

framed maternal incarceration as the number one concern facing incarcerated women.

Departing from scholarly narratives that have documented the abandonment of

15

rehabilitation by various groups invested in reforming the criminal justice system during

this period, I show how advocates for women in prison saw the female offender generally

and the rehabilitative potential of motherhood specifically as opportunities to salvage

penal reform and stave off the punitive turn.19 I then look at state and federal level

responses to advocacy on behalf of mothers in prison in California, showing how

gendered appeals to rehabilitation won important reforms during a period widely believed

to be dominated by punitive, tough on crime policies. Ultimately, however, I show how

the effects of harsh sentencing laws eventually took priority over women’s ability to

mother from behind bars.

Chapter four, “Fertile Ground, 1990-2010,” circles back to the pro-life crisis

pregnancy center movement. The chapter starts with the movement’s rebranding strategy

in the early 1990s and continues to its current day “Urban Initiatives” campaign that

entails targeted expansion into areas considered “high-risk” based on the ratio of crisis

pregnancy centers to abortion clinics. During the period examined in “Fertile Ground,”

crisis pregnancy centers underwent massive expansion, thanks in part to the influx of

Evangelical participation in the movement. However, I also examine this expansion in the

context of state retrenchment of social services to show how the volunteer-based

movement was able to capitalize on a service need created by state abandonment. By its

own admission, the movement serves pregnant women and mothers in need far more

often than it deters women from obtaining abortions. I argue that this need is what keeps

the movement relevant despite its failure to block abortion access.

19 The narrative laid out by David Garland is representative of scholarship discussing the abandonment of rehabilitation. See David Garland, The Culture of Control: Crime and Social Order in Contemporary Society, Chicago, University of Chicago Press, 2001.

16

In the broadest sense, Reconceived is an exploration of what happened to

pregnancy and motherhood after Roe.20 While there are numerous ways one might

answer this question, Reconceived has done so by looking at battles that highlighted the

lack of institutional supports for pregnancy and motherhood. The post-Roe landscape was

defined both by an all-encompassing framework of choice and a widespread institutional

disavowal of pregnancy and motherhood. These realities made it incredibly difficult to

win meaningful supports related to pregnancy and motherhood. The most helpful insights

offered by Reconceived illustrate the ways these two forces intersected to further relegate

reproduction to the private realm of individual responsibility, leaving women facing

poverty, disease, racism, and incarceration to mother as best they could on their own.

Understanding these processes might provide a way to meaningfully support the realities

of pregnancy and motherhood, the majority of which fail to remain neatly contained and

out of sight in spite of widespread reproductive neglect.

20 I am thankful to Anne Gray Fischer for this observation.

17

CHAPTER ONE

From a “World Federation of Emergency Pregnancy Services” to “Bogus

Clinics,” 1970-1990

Introduction

An article in the November 1991 issue of Journal of American Gynecology and

Obstetrics sought to recognize decade of threats to abortion access when it declared the

years between 1977 and 1988 an “epidemic of antiabortion violence in the United

States.” Nearly half of all abortion providers surveyed reported some form of harassment,

ranging from picketing to vandalism. By the time the article reached publication, the

National Abortion Federation was tracking a new category of violence—stalking.21 Due

in large part to the growing force of direct action pro-life groups such as Pro-Life Action

League and Operation Rescue—whose massive civil disobedience demonstrations in the

1980s made the “clinic blockade” an icon of abortion in a post-Roe society—the article

reflected what seemed to be the fever pitch of the volatile abortion debate during this

time. Just two years later the murder of abortion provider David Gunn revealed how the

so-called epidemic of the prior decade was actually the precursor to even greater violence

that would persist into the twenty-first century.22

21 Grimes D et al., “An Epidemic of Abortion Violence in the United States,” American Journal of Obstetrics and Gynecology, 165(5), (1991), 1263-8. 22 Beginning with the murder of David Gunn, four abortion providers and four staff working at abortion clinics were murdered, with the most recent being the murder of George Tiller in 2009. Others have been wounded by shootings while in their homes or bombings while in the clinic. See Jennifer Russo et al., “Antiabortion Violence in the United States,” Contraception, 86 (2012), 562-566.

18

That same year, the National Abortion Federation and the Planned Parenthood

Federation of America co-published a report titled “Anti-Abortion Counseling Centers: A

Consumer’s Alert to Deception, Harassment, and Medical Malpractice” in an attempt to

raise awareness about the true intentions of “antiabortion counseling centers” or crisis

pregnancy centers. Such centers were the product of a broader effort originally described

as emergency pregnancy services (EPS) by pro-lifers. The EPS movement formed in

1971 when pro-lifers, most of them women, set out to provide “alternatives to abortion”

to women facing unplanned pregnancies. These advocates believed a service-based

approach to pro-life politics was the only way to truly render abortion obsolete. The

report described the deceptive and manipulative tactics of crisis pregnancy centers,

including advertising under “Abortion” in the yellow pages and showing graphic images

of dismembered fetuses. According to the report, such abuses evidenced the fact that

“these centers are designed to misinform and intimidate women—some will go to any

lengths necessary to dissuade women from ending their pregnancies.” Women were

warned: “if you find that the facility from which you have sought help is actually an anti-

abortion facility, leave the premises immediately.” 23

Speaking at a national press conference four years prior to these publications in

1987, Planned Parenthood president Faye Wattleton linked pro-lifers who favored

violence and clinic blockades to those running crisis pregnancy centers. “These

extremists resorted to intimidation and even violence to inflict their own views on an

unwilling America. The latest effort in their campaign of deception is the creation of anti-

abortion counseling centers, many of which appear to offer abortion services, but actually

23 “Anti-Abortion Counseling Centers: A Consumer’s Alert to Deception, Harassment, and Medical Malpractice,” National Abortion Federation and Planned Parenthood Federation of America, 1991.

19

lure unsuspecting pregnant women into their clutches under false pretenses.”24 Feminist

attorneys and women’s rights activists also made the connection, with lawyers from the

National Organization for Women (NOW) Legal Defense and Education Fund

recognizing how NOW’s support of a case against a crisis pregnancy center in San

Francisco could “generate publicity about the dishonest and disgraceful activities of

elements of the pro-life movement at a time when criminal cases brought against abortion

clinic assailants are also drawing public attention to the suspect morality of these

people.”25 During a period when unprecedented extremism in the name of life threatened

to discredit the whole of the pro-life movement, abortion rights organizations saw crisis

pregnancy centers as an extension of the fringe element that had reinvigorated and

awakened pro-choice activism.26

In this chapter, I examine the volatile period of the abortion debate through an

exploration of what was originally called the emergency pregnancy services (EPS)

movement. In 1971, as a response to liberalized abortion laws, Catholic, pro-life women

set out to provide emergency pregnancy services to women facing an unplanned

pregnancy. In the minds of these “pregnancy counselors,” legal abortion was equally

24 Quoted in Douglas R. Scott, Jr., “The Making of Controversy: The History of the Conspiracy Against Pregnancy Care Centers,” Life Decisions International, Vol.3, No. 3, Autumn 2000. 25 Memorandum to NOW LDEF Defense Committee from Marsha Levick and Alison Wetherfield, April 1, 1986, p 3, MC 623, Box 448, Carla Abbotts Fake Clinics, 85-90, Schlesinger Library, Harvard University. 26 For the largely dormant pro-choice movement, the same massive protests and rogue bombings that shut down abortion clinics and even killed employees also spurred a new wave of organizing amongst those committed to a “woman’s choice,” and long-time abortion and women’s rights organizations such as National Abortion Rights Action League (NARAL) and the National Organization for Women (NOW) enjoyed growth in both membership and donor funds as a result of the highly visible direct-action tactics championed by pro-life leaders organizing at the margins of the movement. See Faye Ginsburg, “Saving America’s Souls: Operation Rescue’s Crusade against Abortion” in Fundamentalisms and the State: Remaking Polities, Economies, and Militance, Ed by Martin E. Marty and R. Scott Appleby, University of Chicago Press, 1993, 576. For an overview of the various pro-life activities the pro-choice movement was responding to during this time see Suzanne Staggenborg, The Pro-Choice Movement: Organization and Activism in the Abortion Conflict, Oxford University Press, 1991, Ch. 10.

20

threatening to women and a culture of life. The only way to truly render the procedure

obsolete was through providing what they called “alternatives to abortion.” Deeply

committed to a service-based response to Roe, this majority-women faction of the pro-life

movement saw pregnant women in need as their primary concern. Providing women

facing an unplanned pregnancy emotional and material support was, in these advocates’

minds, the only way to ensure they would carry their pregnancy to term. What began as a

relatively small-scale, loosely organized network of “EPS centers” would eventually

become the more than 2,500 crisis pregnancy centers that are in operation today. I trace

the EPS movement from its start in 1971 to the peak of the volatile abortion debate in the

late 1980s and early 1990s.

By following the EPS movement’s evolution, I aim to illustrate two claims. First,

I argue that those who argued for a service response to legal abortion developed a distinct

pro-life philosophy and strategy, one that has been obfuscated by more visible factions of

the pro-life movement as well as pro-choice counter-campaigns that depict EPS centers—

commonly referred to as crisis pregnancy centers (CPCs)—as yet another threat to

choice. Pro-life women who responded to Roe through EPS services were committed to a

vision of compulsory motherhood that is fundamental to the pro-life view, but they went

a step further than their pro-life counterparts by considering what that vision meant for

women. They combined coercive pro-natalism with an—albeit limited—pragmatism

about unplanned pregnancies that set them apart from pro-lifers committed to combatting

abortion through appeals to life. Long before claims of post-abortion syndrome enabled

the pro-life movement to argue that abortion hurt women just as much as the unborn, EPS

21

volunteers centered the pregnant woman and her needs as a mother in their response to

abortion.27

Second, I argue that understanding the history of the EPS movement changes how

we evaluate battles that occurred between the pro-choice movement and the fringe

element of the pro-life movement during the 1980s and early 1990s. Rather than see EPS

centers as yet another aspect of anti-abortion extremism, I instead examine lawsuits

brought against centers in light of the movement’s origins as well as changing cultural

views on abortion and extramarital sex and pregnancy. In doing so, I reveal the

infrastructure of ESP centers to be more diverse than pro-choice accusations of anti-

abortion radicalism would suggest. Scholars who have examined CPCs in their work on

the abortion debate have framed them as extensions of the extremist “threat to choice,”

echoing pro-choice political actors of the 80s and 90s.28 In examining lawsuits against

EPS centers in the context of broader debates regarding pro-life clinic blockades, I try to

resist this “threat to choice” framework, which elides the class politics of both centers’

deceptive advertising and the pro-choice response. Instead, I examine the actual

27 In her book Ourselves, Unborn, Sara Dubow argues that beginning in the 1980s, pro-life organizations developed a “new rhetorical strategy that emphasized the ways that abortion hurt women and fetuses.” Dubow traces how the claim that abortion is psychologically damaging to women worked its way in to medical literature and legal decisions. For women providing emergency pregnancy services in the early 1970s, however, abortion did not represent a psychological threat but an abandonment of pregnant women on the part of the state, a law that “helped” women by providing them with only one avenue with addressing an unplanned pregnancy. EPS volunteers set out to provide women with the “meaningful alternatives” that the state would not. Dubow, Ourselves Unborn: A History of the Fetus in Modern America, Oxford University Press, New York, 2011, p. 153. 28 Crisis pregnancy centers and the emergency pregnancy center movement are virtually non-existent in the academic literature. Save a dissertation published in 2009 on gender and religious identity of movement participants, no works dedicate significant space to crisis pregnancy centers. The following mention centers as an extension of the more confrontational tactics that emerged in the 80s: Faye Ginsburg, Contested Lives, University of California Press, 1998, p 119-121; Dallas Blanchard, The Anti-Abortion Movement and the Rise of the Religious Right, Macmillan Press, 1994, Ch. 7; Suzanne Staggenborg, The Pro-Choice Movement, p. 129-130.

22

circumstances that brought women to EPS centers in order to cast pro-life service

provision in a framework of structural inequality rather than a framework of choice.

In the first part of the chapter I trace the origins of the EPS movement, focusing

on its philosophy and marginalization within broader pro-life politics. I look specifically

at the work of Alternatives to Abortion International (AAI) and the organization’s

attempts to gain recognition from pro-life leaders and governmental officials during the

1970s. I then follow the movement into the 1980s by examining a series of lawsuits

brought against clinics for deceptive advertising. Rather than influencing the direction of

the pro-life movement as AAI so desperately wanted, EPS centers would become

infamously known as “bogus clinics” characterized by a desire to trick women who were

seeking abortion services. I examine concern over the activities of centers against the

backdrop of large-scale clinic blockades that threatened women’s access to abortion and

explore the surprising intersections between legal battles over clinic violence and

lawsuits brought against EPS centers. Ultimately, I attempt to explain how a framework

of choice—particularly during the height of anti-abortion violence in the 1980s—has

obscured the EPS movement and the politics of need that make pro-life service provision

more complicated than a threat to choice.

Creating a World Federation of Emergency Pregnancy Services

Like a number of pro-life groups, those who started emergency pregnancy

services did so in response to liberalized abortion laws that preceded Roe. However,

unlike early pro-life responses that overwhelmingly focused on the fetus, whether

through legislative attempts to overturn Roe with a Human Life Amendment or by

23

emphasizing the “right to life” as the main rhetorical strategy, a small section of pro-life

advocates took a different approach. Reorienting abortion as an equally if not greater

threat to women than to the “unborn life” within her, they set out to provide free support,

emotional and material, in order to ensure that abortion need not be any woman’s

“solution” to an unplanned pregnancy. These early advocates, most of whom were

middle-class, white, Catholic women, felt that the threat of abortion was exacerbated by a

society that stigmatized single motherhood and preferred to hide or demonize women

who became pregnant out of wedlock. Louise Summerhill, a woman who founded the

EPS organization Birthright in Canada in 1969, believed that “very few women want to

destroy their babies if they see another way out. But our society gives a woman little

choice but abortion or a forced marriage. Otherwise she is socially ostracized and

receives little support from the community.”29 Providing those services which society

would not, regardless of a woman’s circumstances, was the fundamental goal of

emergency pregnancy services, and AAI emerged as the force that would attempt to

harness and grow this energy in the early 1970s.

In 1970, a group of pro-life activists met in Chicago to discuss the liberalization

of abortion laws happening at the state level. Inspired by Birthright, the meeting drew

those interested in a pro-life service-based response to the increasing availability of

abortion. It was here that Dr. John Hillabrand, Lore Maier, and Sister Paula Vandegaer

would meet and co-found AAI. The founders were intent on creating a “world federation

of emergency pregnancy services” that they hoped would form a vast network of support

for pregnant women across the globe. Maier, while no more dedicated than her co-

29 This view was widely held by the original founders of emergency pregnancy service centers, many of which modeled themselves after Birthright. Sue Kincaid, The Cleveland Press, Dec 14, 1970, p B6.

24

founders, often conceived of AAI’s role in grandiose terms. “In a way, I envision AAI

and EPS centers as a global entity, much like the Red Cross. While Red Cross enters in

where there are catastrophic natural plights, wars, or other man-caused mishaps that

effect often the multitudes, AAI in contrast deals with individual and personal crisis

where the life of the unborn and the health and well-being of women and families are at

stake.”30

While the infrastructure AAI aspired to create was significant, the emergency

pregnancy services that existed upon the organization’s founding in 1971 were few,

scattered, and uncoordinated. Abortion referral services, on the other hand, were

becoming increasingly common. By the time of AAI’s founding, support was growing for

the wide scale legalization of abortion. One effect of this newfound acceptance was that

abortion referral operations no longer needed to remain underground. Collectives like

Jane in Chicago or one-woman operations like Patricia Maginnis in San Francisco that

helped women obtain illegal abortions were joined by abortion referral services that more

openly directed women to physicians willing to perform the procedure. After Washington

state legalized abortion in 1970, for example, Seattle based feminists founded the

Abortion and Birth Control Referral Service to help direct women to compassionate and

quality physicians.31 Referral services also formed in states that had not yet changed their

abortion law but were in close proximity to states where the procedure was legally

available. For example, the Boston-based Pregnancy Counseling Service, a volunteer

non-profit organization with a board of directors comprised of “medicine, law, clergy,

social work, and business” professionals, counseled 6,000 women during its first year of 30 Letter to Bishop from Maier, Folder Bishop Correspondence, Heartbeat International Internal Records. 31 Jennifer Nelson, More than Medicine: A History of the Feminist Women’s Health Movement, New York, NYU Press, 2015, p. 58.

25

operation in 1970, with 64% of clients successfully terminating their pregnancies in

nearby New York.32

Early EPS operations often borrowed the tactics of abortion referral services and

worried about keeping up with these agencies. Hotlines were a popular first step for

advocates trying to reach pregnant women in need because otherwise these same women

might end up calling a number that led her to an abortion provider. This race to reach the

pregnant woman in need was deeply felt, especially as some newly established hotlines

failed to garner phone calls. In 1971, The Value of Life Committee (VOLCOM) in

Boston, MA created the “Pregnancy Guidance” hotline which encouraged women to

“give their baby a chance for life” by calling the advertised number, while Lifelines of

Western Massachusetts operated a similar referral system.33 Yet four and half months

into operation, VOLCOM was distressed that they had received only thirty calls

compared to the 613 women Pregnancy Counseling Service saw in the month of July

alone. Lifelines in Western Mass was similarly under utilized, and members of

VOLCOM concluded that pro-life agencies were failing to “make even the initial point of

contact with the overwhelming majority of these pregnant and troubled girls.” They

urged the Massachusetts Conference of Bishops to increase support for “a positive well-

advertised and well-packaged program of care for women in pregnancy as a sound

alternative to abortion.”34

32 Pregnancy Counseling Service report, March, 1971, bMS 404/2, George Hunston Williams Papers, Abortion Collection, Harvard Divinity School. 33 “Volcom Speaks…” newsletter, Oct 1972, bMS 404/2, George Hunston Williams Papers, Abortion Collection, Harvard Divinity School. “Statement Before the Massachusetts Conference of Bishops,” Sept 25, 1971, bMS 404/2, George Hunston Williams Papers, Abortion Collection, Harvard Divinity School. 34 For example, in the Value of Life Committee’s statement to the Massachusetts Conference of Bishops, they sighted Pregnancy Counseling Services number of clients as evidence of the fact that despite their attempts with the Pregnancy Guidance hotline, they were not reaching “the majority of these pregnant and

26

Not all early hotline operations reported failure, however. Women mobilized by

California’s abortion reform bill eventually began an operating service called LifeLine in

1971.35 With the help of social service providers working for Catholic Charities, this

initial group of concerned women received training in the principles of “non-judgment

and client determination” and began to train other interested volunteers.36 A second

hotline serving the San Fernando Valley was established a couple of months later, while

the network of trained volunteers eventually reached even further across Southern

California. What had by then become the Right to Life League of Southern California

reported that “the growing use of the lines and the increasing acceptance of the referrals

offered by the trained listener to the person in trouble is heartening reassurance to the

volunteers. They indeed are responding to community needs as well as saving a baby’s

life.”37 Hotlines continued to be a part of emergency pregnancy services, even as physical

clinics became more common as the movement grew. 38

AAI formed with the goal of coordinating these early, isolated efforts. The

organization imagined itself as a clearinghouse for the burgeoning movement of EPS

volunteers. One way it attempted to harness the energies of existing or fledgling centers

was by requesting their affiliation. In return for affiliation dues, AAI provided centers

with advice on how to counsel women facing unplanned pregnancies, a copy of the

annual AAI directory that listed all of AAI’s affiliates, and connected those in the field by

troubled girls.” “Statement Before the Massachusetts Conference of Bishops,” Sept 25, 1971, bMS 404/1, George Hunston Williams Papers, Abortion Collection, Harvard Divinity School. 35 Undated Right to Life training materials, International Life Services Internal Records. 36 Interview with Sister Paula Vandegear, On File with Author. 37 Undated Right to Life training materials, International Life Services Internal Records. 38 For example the Right to Life League helped women in Fond du Lac, Wisconsin start a similar service, “Pregnancy Health Line, Inc.,” in 1978. See “LifeLine Training Program;” “Pregnancy Health Line, Inc. 1978-1979 Annual Report, November 15, 1979,” International Life Services Internal Records.

27

hosting an academy on abortion alternatives every year. VOLCOM advertised AAI’s first

academy in its June 1972 newsletter, urging pro-lifers in MA to attend. “If Massachusetts

is ever to develop a state-wide alternative to the pro-abortion Pregnancy Counseling and

Clergy Counseling groups, there should be a number of Massachusetts women willing in

June to go to Atlantic City or Collegeville, Minnesota to learn the techniques for reaching

and serving the distressed pregnant girl and woman.”39 Workshops on hot line services,

regional expansion, and values in counseling, as well as talks on the philosophy of

involvement in the pro-life movement titled “Is Abortion Really the Best We Have to

Offer?” were characteristic of early conferences.40 Affiliates were also kept up to date on

local and national developments concerning pro-life politics through a newsletter called

Heartbeat. AAI aimed to provide “loose” organization of its affiliates, encouraging them

to tailor their approach to the specific needs of a given area.41

One of AAI’s main interests was helping affiliates become skilled pregnancy

counselors. The architects of EPS imagined their clients to be women facing an

unplanned pregnancy and, in a world in which abortion was readily available, this

situation constituted a crisis. As such, EPS counseling was based on principles of crisis

intervention counseling. The belief that pregnancy counselors served the specific role of

intervening in a moment of crisis is evident in a “Counseling Tips” worksheet AAI

39 Atlantic City is a reference to a conference hosted by Birthright that was listed along with the AAI academy. “Volcom Speaks…” newsletter Vol. 1, No. 6, June 1972, bMS 404/1, George Hunston Williams Papers, Abortion Collection, Harvard Divinity School. 40 These events come from AAI’s 2nd Academy, 2nd Annual AAI Academy Schedule, International Life Services, Inc., Internal Records. 41 Tailoring services to regional needs also meant being cognizant about prevailing political beliefs when it came to advertising. An early Heartbeat Newsletter advised affiliates that in order for the names of their centers to be effective they should “first engage the attention, arouse curiosity, suggest an element of hope, and preferably, not appear excessively moralistic…many different names might be required to suit the conditions prevailing in various areas and nations,” Heartbeat Bulletin Oct 1971, Vol 1, No 2, BMS 404/9, George Hunston Williams Papers, Abortion Collection, Harvard Divinity School.

28

distributed to its affiliates in 1972. “The goal of an emergency pregnancy volunteer is not

to do in depth counseling. It is not to solve all of the girl’s psychological problems (even

if that were possible). The goal of the counsellor [sic] is to provide an emergency service,

often centering around the decision to abort the baby or bring the baby to term.”42 AAI

instructed affiliates that the attitudes of the counselor included “acceptance,” a “non-

judgmental attitude,” and “listening,” with listening being one of the most important

components of good counseling. “As easy as it sounds, this is one of the most difficult

jobs for a volunteer. We must give the girl the feeling that she may say anything she

wants to us, and she will be heard. She will not be interrupted or judged. A girl does not

come to us to be told what to do. She comes to sort out her own feelings and attitudes.”43

In exchange for AAI’s guidance and resources, affiliates were required to adhere

to the organization’s six pro-life principles. These principles made up the organization’s

philosophical underpinnings. Affiliates had to promise not to discriminate on the basis of

“race, creed, color, national origin, age, marital, or socioeconomic status” and maintain

client confidentiality. However, AAI’s vision of client protection also involved a vested

interest in clients’ sexual and reproductive practices. AAI’s sixth principle, therefore,

forbade affiliates from referring “abortions or abortifacients” to clients. The inclusion of

abortifacients reveals that AAI was one of the early pro-life organizations to subsume

birth control under a framework of abortion. As AAI’s affiliates increased and the

42 “Counseling Tips,” AAI Education Committee-Sister Paula Vandegaer, June 1972, bMS 404/8, George Hunston Williams Papers, Abortion Collection, Harvard Divinity School. Vandegaer was one of the main social workers from Catholic Social Services that had helped women in Southern California develop guidelines for EPS counseling prior to the formation of AAI. Her role in the organization no doubt ensured that professional counseling techniques were a major part of AAI’s support to affiliates. 43 Ibid.

29

organization became more visible, this principle would set AAI apart from other pro-life

efforts.44

AAI also offered organizational support, serving as a resource clearinghouse for

individuals wanting to learn more about how to establish emergency pregnancy services

in their towns and cities. Oftentimes, AAI was able to direct these individuals to nearby

centers already in operation.45 Sandra Solano wrote from Baltimore asking how she could

help “women and girls in my community and state.” She shared that she had an abortion

at 19, but a year later she gave birth to a son. “I love my son and I want to help anyone in

any way that I can.”46 Other times AAI acted as a referral service for potential clients.

Ritaellen Burk, a seventeen year old with a six month-old son, wrote in hopes of finding

“moral and financial support” from a local EPS. “My son’s father left me when I became

pregnant. And not having no one to turn to besides my parents I was in a sense of the

word forced to have and keep my child…Please don’t get me wrong I love my son very

much and far from regeting [sic] having and keeping him.” AAI co-founder Sister Paula

Vandegaer instructed the center Friends of Life in West Palm Beach to get in touch with

Ritaellen and “give her whatever encouragement and support you can.”47

Maier more so than the other founders worked to tether the success of the

movement to AAI’s support. She often highlighted affiliates’ successes in the Heartbeat

newsletter. For example, EPS advocates in Montana had twenty centers by 1973, leading

44 “AAI Manual, Section II,” Heartbeat International Internal Records. 45 Letter to Florence Gass from Sister Paula, April 4, 1980, Letter to Barbara Cook from Sister Paula, Feb 1980, Letter to Lucy Goetz from Sister Paula Jan 24, 1980, Folder EPS Correspondence, International Life Services Internal Records. 46 Letter to Sister Paula from Sandra Solano, no date, Folder EPS Correspondence, International Life Services Internal Records. 47 Letter to AAI from Ritaellen Burk, Sep 16, 1979, Letter to Friends of Life from Sister Paula, Folder EPS Correspondence, International Life Services Internal Records.

30

Maier to conclude that the state “is alert and doing something about it,” while Centers in

Geauga County of Ohio reported that they had received funds from the State Mental

Health Board to cover psychiatric consultant fees offered by their centers. 48 Maier

declared the development a “breakthrough in the area of securing public funding for Pro-

Life EPS Centers” and an “acknowledgement of the fact that these centers do perform a

service which contributes to the improvement of mental health in those persons who are

distressed by pregnancy.”49

By 1975, AAI boasted of having over 700 EPS affiliates in the U.S., all of which

provided services free of charge thanks to pro-life counselors and their loyal donors.50

The number of EPS operations affiliated with AAI more than doubled between August of

1972 and December of 1973, a period that spanned both the months leading up to and

year following the Supreme Court’s decision in Roe v. Wade.51 Recognizing this growth,

the January 1975 issue of Heartbeat News Bulletin was dedicated entirely to “Starting a

Pro-Life Emergency Pregnancy Service Center” in response to the “numerous inquiries

received from many new groups planning to establish Emergency Pregnancy Services,

and as a service to all the newly formed EPS centers within the last year.”52

Yet despite the influx of letters, annual academies, and the creation of Heartbeat

Magazine, a publication dedicated solely to emergency pregnancy counseling, AAI did

48 Heartbeat News Bulletin, Sept 1973, Vol 5, No 3, BMS 404/8, George Hunston Williams Papers, Abortion Collection, Harvard Divinity School. 49 Heartbeat News Bulletin, Aug 1973, Vol 5, No 2, BMS 404/8, George Hunston Williams Papers, Abortion Collection, Harvard Divinity School. 50 Letters to Senators Kennedy and Bayh from Hillabrand and Lore, December 1 and 4 respectively, 1975, Heartbeat International Internal Records (Sen Ken/Sen Bayh, photo 2, 13) 51 AAI went from having 181 affiliates in 1972 to 467 affiliates in 1973. AAI’s Worldwide Directory of Emergency Pregnancy Services, Aug 1972 and Dec 1973 editions, George Hunston Williams Papers, Abortion Collection, Harvard Divinity School. 52 Heartbeat News Bulletin, Jan 1975, Heartbeat International Inc. Internal Records.

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not have the prominence it desired within the pro-life movement. While explicitly non-

sectarian, those involved in emergency pregnancy services early on were largely

Catholic, and as a result the founders desperately sought recognition and support from the

National Council of Catholic Bishops (NCCB).53 Feeling the financial strain from the

very moment of founding AAI, Maier especially felt overlooked by the NCCB when it

came to monetary support. She attributed the NCCB’s dismissal to a misguided

evaluation that serving pregnant women was not the way to end abortion. “In most

instances the EPS centers have begun and carried on without support from church or

government. In far too many instances, it is because the nature, scope and importance of

their programs have not been understood, or have been confused with Right to Life

Societies. It is, for example, not too uncommon and it is very frustrating for the service

centers to hear, ‘We have already given to you in the last Right to Life Drive!’”54

Dedicated pro-life counselors occupied a complicated position within the broader

pro-life movement. While AAI had grown significantly as an organization since its

founding in 1971, emergency pregnancy services were rarely recognized as a viable

political tactic in the fight for life. Much of the movement’s leadership continued to

invest energy in overturning Roe with a Human Life Amendment. As the abortion debate

evolved, AAI would continue to raise its profile and attempt to take advantage of federal

level abortion and family planning politics. In the process, AAI’s stance on abortion

referral would result in the organization being further marginalized in discussions

53 In a letter to the President of the NCCB and Archbishop of Cincinatti Joseph L. Bernadin, Dr. Hillabrand wrote to ask for a public statement of approval from the NCCB on AAI’s operations. Hillabrand confided in Bernadin that while the organization “makes every effort to protect and maintain its avowed non-sectarian image...It is unrealistic not to acknowledge that the greatest reservoir of strength and manpower in the service effort is found among the committed Roman Catholics.” Letter to Bernadin from Hillabrand, Dec 28, 1975, Heartbeat International Internal Records. 54 Letter Joseph L. Bernadin from Lore Maier, Dec 4, 1975, Heartbeat International Internal Records.

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regarding the appropriate role of the state in aiding pregnant women. AAI felt strongly

that it knew what was best for women facing an unplanned pregnancy and continued to

position the movement as women’s most valuable advocate.

Confronting an “Epidemic” of Teen Pregnancy

The possibility of a legislative solution to abortion in the years immediately after

Roe seduced grassroots activists and Congressional representatives just as much as it did

religious leaders. Investing in the legislative strategy had already served pro-lifers well,

as organizing at the state level had resulted in successfully blocking efforts to liberalize

existing abortion laws prior to the Roe ruling.55 Local Right to Life chapters were vital to

this project, and they threw their weight behind the plan get a human life amendment

through Congress. Even though the amendment reached a floor vote only once despite

three hundred different drafts between 1973 and 1983, it consumed the majority of the

movement’s support and resources in the years following Roe. AAI’s commitment to

emergency pregnancy services was competing with a much greater commitment to this

legislative strategy. As such, it would take a different political issue for AAI to be

presented with the opportunity to carve out a position for itself within the greater terrain

of the abortion debate. As the nation contemplated how best to respond to an “epidemic”

of teen pregnancy, AAI attempted make the case for both its expertise in serving pregnant

women and its superior pro-life strategy.

Just a year after abortion became legal in the United States, the results of a 1971

study by two professors of Population and Public Health at John Hopkins University

55 Between 1971 and 1972 such efforts defeated attempts to liberalize abortion laws in thirteen states. See Self, All in the Family, p. 155.

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were featured prominently in newspaper headlines.56 Extrapolating from a random

sample of almost 5,000 girls, the researchers estimated that by 1971 a total of 1.1 million

teenagers had experienced their first pregnancy.57 Soon, reports of the teen pregnancy

crisis were emerging from Nassau County, Long Island, Cook County, Chicago,

Philadelphia, Pennsylvania, and Santa Ana, California. By 1978 the epidemic had made

its cinematic debut in a documentary called “And Baby Makes Two” that gave viewers

the “real story behind the statistics.”58 That same year, the newly minted president of

Planned Parenthood, Faye Wattleton, declared teen pregnancy the number one population

problem in the United States, effectively stoking fears about the new epidemic by

invoking the older one of overpopulation.59

At a time when the abortion debate was increasingly forcing Congressional

representatives to identify as “pro-life” or “pro-choice” candidates, the teen pregnancy

epidemic and its unavoidable connection to the politics of birth control and, to a lesser

extent, abortion made for an incredibly fraught political terrain. It was in response to the

political difficulty of navigating the issue of teen pregnancy that “alternatives to

abortion” would become a topic of Congressional debate. Democratic Senators Birch

Bayh and Edward Kennedy first sponsored what they titled alternatives to abortion

56 The study was supported by a grant from the National Institute of Child Health and Human Development and first appeared in a government publication titled Demographic and Social Aspects of Population Growth, U.S. Government Printing Office, Washington, D.C. 1972. Subsequent writings based on this original research appeared in various issues of the journal Family Planning Perspectives. The study that made its way to the New York Times article referenced below was published as Zelnik, Melvin and John F. Kantner, “The Resolution of Teenage First Pregnancies,” Family Planning Perspectives, 6(2), Spring, 1974: 74-80. 57 Jane E. Brody, “Study Examines Teen Pregnancy: Three out of 10 Who Have Intercourse Conceive,” New York Times, Jun, 28, 1974. 58 Barbara Isenberg, “Special Story of Teen Pregnancy,” Los Angeles Times, Feb 27, 1978. 59 “Around the Nation,” New York Times, December 4, 1978.

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legislation in 1975.60 Both of their bills would provide services targeted at the population

of young women facing unplanned pregnancies. Modeled after the Joseph P. Kennedy, Jr.

Foundation’s efforts to address teen pregnancy through the creation of “life support

centers,” the legislation commended the “one stop shop” model that the Foundation had

started in East Baltimore, a place where young pregnant women could obtain all the

services they needed to make it through their pregnancy. Based on the belief espoused by

EPS advocates that single women sought out abortions because “there’s nobody helping

her keep her baby,” both the Foundation and the alternatives to abortion legislation

framed teen pregnancy as an opportunity to address the social and financial pressures

affecting women that went unaddressed by arguments for life. “A constitutional

amendment isn’t going to stop abortions in East Baltimore,” stated presidential hopeful

Sargent Shriver, who instead suggested “love, compassion, and education.” For some, the

teen pregnancy epidemic offered an opportunity to move the abortion debate beyond the

pro-life push for a Human Life Amendment.61

Redirecting the debate on abortion, however, was no easy task. Executive

Director of the National Right to Life Committee Ray White warned his Board of

Directors to be suspicious of those promoting alternatives to abortion for the concept was

“fast becoming a smoke screen for obscuring our real objective which is to secure a

Human Life Amendment. It is becoming a popular haven for candidates for the

presidency who are either pro-abortion oriented and/or those who say they are personally

60 Both bills set out to amend the Public Health Services Act. Kennedy’s was named the National School Age Mother and Child Health Act while Bayh’s was named the Life Support Centers Act. 61 Jim Castelli, Interview with presidential hopeful, Sargent Shriver, North Country Catholic, Oct 22, 1975. For example, Bayh’s Life Support Centers bill emphasized the fact that “the teenage group is particularly vulnerable to unplanned pregnancies,” see letter to Senator Birch Bayh from John Hillabrand and Lore Maier, Dec 29, 1975, Heartbeat International Internal Records.

35

against abortion…”62 Similarly, President of the Maryland Right to Life chapter Tom

O’Herron feared that talk of alternatives would weaken “the resistance of the pro-life

movement to abortion.”63 While pro-lifers dedicated to reversing Roe saw the legislation

as a sign of a weak or disingenuous anti-abortion stance, family planning advocates

pushing for increased birth control services considered the proposals unlikely to go

anywhere given recent attempts by the Ford Administration to cut funding for family

planning.64 Additionally, because most of the funds in the proposed bills were earmarked

for services that would aid women who were already pregnant, it was difficult to garner

backing from representatives who considered prevention the best solution to teen

pregnancy.

AAI, however, reacted to the proposals with an altogether different form of

criticism—indignation that, once again, their organization had been overlooked. Media

reports covering the legislation attributed the concept of alternatives to abortion to Bayh

and Kennedy, and this deeply offended AAI’s co-founders.65 In addition to writing both

Senators to inform them of the organization’s work, Hillabrand and Maier made sure to

let the Wall St. Journal know that their “readership could have derived incomplete and

inaccurate information” from a column covering the legislation that had accused anti-

abortionists of failing to provide alternatives.66 From the perspective of AAI, its affiliates

were already providing women with this service. Even more concerning was the fact that

62 Memorandum from Ray White to NRLC Board of Directors, Oct 31, 1975, Folder 1975 Correspondence, International Life Services Inc. Internal Records. 63 Letter from AAI to Tom O’Herron, Nov 30, 1975, Folder 1975 Correspondence, International Life Services Inc. Internal Records. 64 Alan Otten, Politics and People, Wall St. Journal, November 28, 1975. 65 Ibid. 66 Letter to Bayh from AAI, Dec 4, 1975, Letter to Kennedy from AAI, Dec1, 1975, Letter to the Editor at the Wall St Journal from AAI, Dec 12, 1975, Heartbeat International Internal Records.

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the legislation was at risk of missing an important opportunity to utilize (and fund) the

already existing network of AAI affiliated centers dedicated to providing alternatives to

abortion.

In spite of their bruised egos, the AAI founders also saw opportunity in the

legislation. This was a chance to offer their expertise to those who were seriously

considering how to best support pregnant women. Yet upon securing a conference with

various Health, Education and Welfare (HEW) officials in order to demonstrate AAI’s

ability to provide alternatives to abortion nationwide, it quickly became apparent that

important differences would prevent the public-private partnership both parties hoped

would be possible. The problem resided in AAI’s sixth pro-life principle, which barred

affiliates from referring abortion or abortifacients. In response to HEW officials’

concerns that AAI’s EPS centers might not offer clients the “full range of services,”

Maier countered that “those offices which arrange and purvey abortion for profit” were in

actuality more likely to be limited in the options they could provide. She went onto

inform officials that as a matter of policy, centers discussed the full range of options with

clients so as to ensure truly “informed consent” while also offering help “before and after

childbirth, as well as before and after abortion.”67 This did not, of course, sway HEW

officials. AAI’s stance made it ineligible for funding from federally sponsored programs.

Bayh and Kennedy’s bills stalled quickly, so AAI’s initial foray into federal

funds and authority was momentarily moot. But with the administration change, and an

ever-growing concern over teen pregnancy, alternatives to abortion became a highly

contested congressional issue. Upon becoming Secretary of Health for the Carter

67 Letter to Charles Lowe, Special Assistant for Pediatric Affairs, Dept of HEW, from Lore Maier, March 3, 1976, Heartbeat International Internal Records.

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Administration, Joseph A. Califano Jr. appointed two study groups—one to research

alternatives to abortion and the other to research teen pregnancy. Califano shared Carter’s

opposition to abortion and made it his goal to find alternatives. Just months into the

alternatives to abortion research project, however, the head of the committee, Connie J.

Downey, disbanded the project out of frustration with the very concept. In what would

become a widely circulated quote from a leaked memo meant only for Califano, Downey

wrote that abortion “is an option, uniquely, which is exercised between conception and

live birth. As such, the literal alternatives to it are suicide, motherhood, and, some would

add, madness. Consequently, there is some confusion, discomfort, and cynicism greeting

efforts to ‘identify’ alternatives to abortion.”68 Within the gridlocked abortion debate,

alternatives to abortion were an untenable political proposition. Whereas pro-lifers saw

such initiatives as weak on abortion, pro-choicers, as Downey’s words make clear,

considered such a proposal complete absurdity, an attempt to obscure what was actually

an anti-abortion initiative.

While Downey’s taskforce disbanded, the taskforce on teen pregnancy delivered.

It submitted a report to Califano that outlined the importance of abortion access in

lowering rates of teen pregnancy and problematized the fact that this recommendation

was impossible as a result of the recently passed Hyde Amendment. One of the pro-life

movement’s greatest legislative victories, the Hyde Amendment barred any federal funds

from being used to perform abortions, leaving it up to states to decide whether or not to

fund abortions with state Medicaid funds.69 It also heavily recommended increased

federal funding for family planning, giving momentum to those advocating for prevention 68 Associated Press, “U.S. Abortion Panel Disbanded by Chief: Head of Administration Group, in Memo, Records Frustrations,” New York Times, Nov 27, 1977. 69 Currently, 15 states allow for Medicaid to cover abortion.

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in the face of teen pregnancy. Califano’s investment in alternatives to abortion continued

to be supported by only a minority of Congressional representatives with pro-life

sympathies, and it became clear that family planning would have to be included if a bill

was going to get through Congress.70

Debates over alternatives to abortion, teen pregnancy, and family planning

culminated in the passage of The Adolescent Health Services and Pregnancy Prevention

Act in 1978, which established the Office of Adolescent Pregnancy Programs. This

legislation provided AAI another opportunity to assert its particular brand of pro-life

politics. The organization was deeply concerned about the referral requirements for

service agencies that might receive funding through the legislation.71 In addition to

alerting affiliates of how the funding compromised AAI’s pro-life principles, AAI sent an

“Urgent Notice” to other pro-life groups informing them that receiving funds would

require groups to refer abortion services. While the American Life Lobby and the

National Conference of Catholic Charities expressed their emphatic support for AAI’s

stance, the Joseph P. Kennedy Jr. Foundation countered AAI’s accusations.72 Responding

specifically to the requirement of abortion referral, a representative of the Foundation

attempted to finesse the boundaries of making a referral. “Programs are not mandated to

refer her, but she must be informed if she asks that counseling can be carried out at such-

and-such agency, but she need not be referred. If Projects were to be required to refer for 70 Steven Roberts, “Funds Emerge to Help Pregnant Teen-Agers: An Idea Emerges and Gets in Budget,” New York Times, Jan 24, 1978. 71 For a detailed discussion of how Senator Kennedy’s 1975 School-Age Mother and Child Health Act eventually and successfully culminated in the 1978 Adolescent Health Services and Pregnancy Prevention Act, particularly with the emphasis being on helping young pregnant women as opposed to pregnancy prevention, see Maris Vinovskis’s An ‘Epidemic of Teen Pregnancy?: Some Historical and Policy Considerations (Oxford: Oxford University Press, 1987). 72 Letter to Sister Paula from Judie Brown, President of American Life Lobby, Nov 30, 1979 and Letter, to Sister Paula from Dorothy Bird Daly, Assistant Director of National Conference of Catholic Charities, March 21, 1980, International Life Services, Inc. Internal Records.

39

abortion or abortion counseling, the Kennedy Foundation would have been opposed to

the legislation.”73

In response Vandegaer, who was now editor in chief of AAI’s pro-life counseling

publication Heartbeat Magazine, published the letter in her Editor’s Notes section under

the heading “A Wolf in Sheep’s Clothing: Public Law 95-626.”74 While this was not the

first notice AAI had given to its affiliates and larger pro-life readership, the letter from

the Kennedy Foundation was hard proof that federal pregnancy programs compromised

AAI’s pro-life principles.75 Taking issue with the Foundation’s assertion that “she must

be informed if she asks,” Vandegaer reminded readers of Heartbeat that truly informed

pro-life counseling entailed expressing “care for her so much that we will not even give

her information about agencies that perform abortions or do abortion counseling, nor can

we give her a phone number where she can get such information. Not only are we under

no obligation to tell the girl where abortions are done, but rather, we are under obligation

NOT to tell her. In this way we are true to our own principles and true to the best interests

of the young woman.”76 With the letter from the Kennedy Foundation, AAI was able to

position itself as superior to other pro-life organizations also pursuing alternatives to

abortion. In staunchly rejecting the position that “giving the name of an agency is a

73 Letter to Lore Maier from Robert E. Cooke, Chairman of Scientific Advisory Board for Joseph P. Kennedy Jr. Foundation, March 10, 1980, International Life Services, Inc., Internal Records. 74 Heartbeat Magazine, Vol. 3, No. 2, Summer 1980, bMS 438/3, George Hunston Williams Papers, Abortion Collection, Harvard Divinity School (photo 76). 75 In addition to answering individual queries from affiliates, AAI also addressed the topic in their Winter 1979 Heartbeat issue, bMS 438/1, George Hunston Williams Papers, Abortion Collection, Harvard Divinity School. Founders Lore Maier and Sister Paula pursued clarification of the bill’s requirements from Lula Mae Nix, Director of the newly created Office of Adolescent Pregnancy Programs, despite their suspicions that it was in fact inconsistent with AAI principles. See letter to AAI Trustees from Sister Paula, November 28, 1979, and Sister Paula’s notes detailing Dr. Nix’s response to the question of abortion referrals, December, 11, 1979, International Life Services Inc. Internal Records. 76 Heartbeat Magazine, Vol. 3, No. 2, Summer 1980, bMS 438/3, George Hunston Williams Papers, Abortion Collection, Harvard Divinity School (photo 76).

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simple informational item,” AAI and its dedicated affiliates were able to tell followers

that they remained “the only true ‘alternatives to abortion services’ in the U.S.A.,” even

as Congress passed legislation that might actually make it easier to support young,

pregnant women.77

During its first decade of operation, AAI had to balance its vision of achieving a

robust network of EPS centers and its adherence to pro-life principles that positioned it to

the right of Congressional efforts to walk the line between pregnancy support and

abortion politics. While debates over teen pregnancy seemed like an opportunity for AAI

to gain the legitimacy it desired, its strict pro-life principles made it incompatible with the

some of the first groups willing to recognize the value of a service-based approach.

Ultimately, AAI used federal teen pregnancy programs to bolster its credentials amongst

its supporters. Yet as social acceptance of sex and childbirth out of wedlock as well as

abortion grew, EPS advocates would face additional challenges in their efforts to provide

counseling to the women who found their services.

“Bogus” Clinics

As the EPS movement continued to expand, they faced shifting cultural mores

regarding sex, abortion, contraception, and marriage. A 1980 issue of Heartbeat

Magazine, for example, reported the emergence of a new trend in clientele—half of the

women visiting EPS centers to obtain a pregnancy test ended up with a negative result.

The magazine urged volunteers to counsel these women on the dangers of extramarital

sex despite there being no pregnancy. Additionally, centers were encountering more

77 Letter to Lincoln Oliphant, Administrative Aid to Senator Jake Garn, from Lore Maier, December 27, 1979.

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women intent on obtaining an abortion.78 As centers proliferated, the EPS belief that

pregnant women turned to abortion because they lacked support was challenged by an

increasing number of women who did not fit the profile imagined by pro-life service

providers. Rather than letting these clients pass through, however, EPS advocates saw

sexually active unmarried women and women seeking abortions as the clients most in

need of support.

During this same period, other pro-life organizations began investing in the

alternatives to abortion approach. Christian Action Council (CAC), an Evangelical, pro-

life lobbying group founded in 1975, began developing its “Crisis Pregnancy Center

ministry” in 1980. By 1984, it had over a hundred centers.79 An organization called

Pearson Foundation, Inc. also increased its profile and the number of centers it was

coordinating.80 Even Jerry Falwell announced that his ministry would begin developing

“Save-a-Life” centers, with the hopes of establishing 1,000 across the country.81 Both

CAC and Pearson functioned as umbrella organizations like AAI, and while AAI

collaborated with the founder of Pearson Foundation Rob Pearson, these organizations

oversaw distinct groups of center affiliates. In other words, the number of centers grew at

the same time the volunteers staffing them diversified, and AAI was no longer the only

organization offering support to EPS advocates.

78 Heartbeat Magazine, Vol. 3, No. 4, Winter 1980, p. 4-5, bMS 438/1, George Hunston Williams Papers, Abortion Collection, Harvard Divinity School. 79 Christian Action Council Newsletter, “Abortion, It’s a Lonely Word,” December 1, 1984, bMS 438/3, George Hunston Williams Papers, Abortion Collection, Harvard Divinity School. 80 It is unclear when Pearson Foundation, Inc. began. A flier from International Life Services Records advertising a conferenced hosted by Pearson reads “Pearson Foundation, Inc. since 1970,” but Rob Pearson who seemed to extend the Foundation’s activities to Hawaii does not show up in AAI materials until the late 1970s. 81 “A Release of Virtue: Alternatives to Abortion,” Gary Bergel, n.d. MC 496, Box 74, Folder “Fake Clinics, 1984,” NOW Recs 1959-2002 (Inclusive), Schlesinger Library, Harvard University.

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The increase in centers was accompanied by another development in the pro-life

movement—the emergence of more confrontational and sometimes violent tactics. The

movement grew a direct-action arm that favored picketing in front of abortion clinics,

harassing abortion providers and sometimes participating in property damage. Groups

like the Pro-Life Action League and, later in the decade, Operation Rescue staged large,

high profile, emotionally charged protests by organizing clinic blockades that

successfully shut down abortion clinics. This volatile turn in the abortion debate extracted

much of the energy of the pro-choice and women’s rights organizations at the same time

that the whole of the pro-life movement became associated with anti-abortion zealotry.

More clients looking for birth control and abortion, an increase in EPS centers,

and the volatile turn in the abortion debate defined the terrain in which the EPS

movement would emerge from obscurity. While AAI had hoped to become a national

leader in alternatives to abortion, the American public would become familiar with

pregnancy crisis centers from an altogether different source—lawsuits brought on behalf

of women claiming mistreatment by clinics. Enough lawsuits were brought over the

course of the 1980s that a Congressional hearing was ultimately held for the purposes of

investigating what came to be known as “bogus clinics.” Beginning in 1984, women who

had visited centers advertising free pregnancy tests and abortion information attempted to

sue clinics for false advertising and emotional distress. Upon arriving at the clinic for a

pregnancy test, women often encountered long wait times for their results, during which

over-zealous counselors warned them of the physical and psychological risks associated

with abortion. Sometimes counselors drove home their message with visual aids such as

pictures of bloody fetuses or videos that described abortion in gruesome terms: “the baby

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is torn apart and removed…pulled into a suction tube with tiny plastic teeth…clearly the

life of a human being has ended.”82 As reports of these practices became more frequent,

female journalists and reproductive rights activists took to visiting clinics “undercover”

in order to expose the shocking practices.83

Because of the movement’s obscurity up to this point, all EPS centers came to be

known as “bogus clinics.” This sweeping classification, however, overlooked the

diversity in services offered by centers as well as the motivating factors that brought

women to such centers in the first place. As a result of AAI’s commitment to center

autonomy, immense variations in center services and tactics existed. Generalizations

about the pro-life movement’s turn to extremism as well as a lack of intervention on the

part of EPS leaders culminated in “bogus clinics.” Complicating the “bogus clinic”

narrative matters because it too easily dismisses alternatives to abortion and the women

who sought out services.

Shanti Friend was the first woman to bring a suit. She visited a center in Torrance,

CA run by the Right to Life League of Southern California, the organization that had

started Lifeline in 1971.84 Thinking she might be pregnant and in search of a low-cost

abortion, Friend sought the services of Pregnancy Counseling Center-South Bay because

82 Krieger, Lisa. “Just the Facts?” City Paper, Feb 21,1986, NOW Records, 1959-2002, MC 496, Box 77, Folder Fake Clinics: Pro-Life Pregnancy Centers, 1984, 1986. 83 A number of articles at this time took this approach, and contemporary reports continue to do the same. See for example Krieger, Lisa. “Just the Facts?” City Paper, Feb 21,1986; Bolotin, Susan, “Selling Chastity—the Sly New Attack on Your Freedom,” Vogue, March 1986; Bader, Eleanor, “Bogus Clinics Offer Prayers, Not Abortions, Guardian, April 16, 1986. All in NOW Records, 1959-2002, MC 496, Box 77, Folder Fake Clinics: Pro-Life Pregnancy Centers, 1984, 1986. See also Barker, Teresa, “Testing Anti-Abortion ‘Clinics’” Chicago Tribune, March 15, 1987 84 By that time the Right to Life League had expanded to operating 25 crisis pregnancy centers located throughout southern California.

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it advertised free pregnancy tests and pregnancy counseling in the yellow pages.85 While

her pregnancy test was being processed, her counselor showed her pictures of mutilated

fetuses, told stories of women who died from abortions, and warned that the procedure

could cause future miscarriages or premature births.86 The presiding judge ruled that

diagnosing a pregnancy was a medical act, something the Pregnancy Counseling Center

performed without the medical license required by the state of California. As a result, the

twenty-five centers operated by the Right to Life League were barred from advertising

under “Clinics” in the yellow pages, advertising “free pregnancy testing,” and collecting

urine samples for lab analysis.87 Suits against Mother and Unborn Baby Care of North

Texas, Inc. and the Problem Pregnancy Center in Fort Worth, TX followed, with a ruling

that the clinics were guilty of deceptive trade practices.88 Investigations into three centers

in New York City by Attorney General Robert Abrams resulted in a similar ruling, and

individual cases would continue to be brought by abortion and women’s rights advocates

in North Dakota, Maryland, Missouri, and Northern California into the mid 1990s.89

While the centers were distinct, their tactics became increasingly familiar with

each new report of a lawsuit or undercover expose. Eventually, the Pearson Foundation

would emerge as the common link in the cases. Considered the creator of these deceptive

practices, Pearson was also deemed responsible for the whole of the EPS movement.

85 Townsend, Dorothy, “Judge Rules Out Pregnancy Tests at 15 Right to Life League Centers,” Los Angeles Times, Sep 27, 1985, B6. 86 Oliver, Myrna, “Right to Life League Sued; Woman Claims Deception,” Los Angeles Times, Jan 23, 1985, C6. 87 Superior Court of the State of California for the County of Los Angeles, C 531 158, Statement of Decision, Oct 18, 1989, Personal Records of International Life Services. 88 Landsberg, Michelle, “‘Fake abortion clinics’ a pro-life front for emotional violence,” The Globe and Mail, October 11, 1986. 89Jane Gross, “Pregnancy Centers: Anti-Abortion Role Challenged,” New York Times, January 23, 1987; Kevin Sullivan, “Group Pickets Antiabortion ‘Clinic’ in MD,” Washington Post, November 3, 1991.

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Whereas AAI had developed from the idea that women needed emergency counseling to

face their pregnancy and that such counseling needed to be non-judgmental, Pearson’s

educational materials had a different take on pregnant women who wanted abortions—

they needed to be “educated in what abortion really is.”90 For Pearson, “abortion-seeking

women” were unaware that abortion entailed the murder of innocent life. As such, they

needed to be informed, preferably through a graphic slideshow called “Caring” that

detailed the “results of abortion.” According to Pearson, the “success rate of saving

mothers and her unborn child from abortion is about 75-85%, largely depending upon the

use of the Pearson Foundation slide presentation.” In the eyes of other pro-life leaders,

Pearson’s approach to alternatives to abortion was worthy of recognition. President of the

National Right to Life Committee Jack Willke praised Pearson for promoting “a whole

new concept of offering alternatives to pregnant women in trouble.” 91

While the Pearson Foundation could only claim 100 affiliates in 1982, it is quite

possible that Pearson’s preferred tactics extended beyond his own network of centers. Far

from a rogue element, Pearson served as AAI’s Chairman of Emergency Pregnancy

Services Development Program in addition to overseeing his own Foundation. As a

result, Pearson advised far more centers on their approach to service provision than his

own 100 centers that were required to adhere to the Foundation’s strict protocols.92 For

example, when Joan Brown expressed an interest in setting up an Emergency Pregnancy

Services center in Traverse, PA and asked AAI about local trainings, Pearson sent her a

package of information in which he highlighted “the audiovisual material mentioned on

90 “The Pearson Foundation: Saving Babies and Their Mothers,” n.d., MC 496, Carton 78, Folder “CPCs ‘Fake Clinics,’ 1985,” NOW Recs, 1959-2002 (Inclusive), Schlesinger Library, Harvard University. 91 Ibid. 92 Letter to “Friend for Life” from Robert Pearson, International Life Services Internal Records.

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page two of the attached,” assuring her that “this presentation has been proven extremely

useful in our educational efforts.”93

Sources do not make clear how AAI reconciled its commitment to non-

judgmental and compassionate counseling with Pearson’s slideshow. What is clear is that

at least some of AAI’s affiliates were strongly opposed to Pearson’s tactics—so much so

that they threated disaffiliation. At an AAI Trustee Meeting in 1982, trustees discussed

the fact that some areas would withdraw from the organization if showing Pearson’s

slideshow was official policy. The trustees voted to establish that “showing Caring is not

the policy of AAI.”94 However, as evidenced by the lawsuits and exposés, it is clear that

Pearson’s more aggressive tactics and explicit instruction to target women looking for

abortion drew volunteers into the EPS movement who were not so easily compelled by

calls for non-judgmental and compassionate emergency pregnancy counseling.

Pearson’s involvement with AAI went unrecognized by mainstream media or pro-

life magazines. The organization’s obscurity combined with the attention given to

Pearson ensured that lawsuits highlighting deceptive tactics never revealed the broader

EPS movement and its history. At the same, pro-choice advocates attempting to rally

opposition to anti-abortion violence and increasingly frequent clinic blockades seized

upon the slideshow, interpreting it as an extension of the violent arm of the pro-life

movement. The pro-choice response cemented the connection between Pearson, the EPS

movement, and anti-abortion violence. With this framing in place, the class politics of

both EPS services and the lawsuits brought against them would be overlooked. The

understanding that pro-life deception was the main motive behind EPS services obscured

93 Letter to Joan Brown from Robert Pearson, April 13, 1979, International Life Services Internal Records. 94 AAI Board of Trustees Meeting, August 13, 1982, International Life Services Internal Records.

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how offers of free support and services garnered the attention of women in need of low-

cost reproductive health care.

Take, for example, the case of Carla Abbotts. In 1986, Abbotts, a white, low-

income woman, visited the law office of Ann E. Menasche and Julise M. Johnson in

order to file suit against A Free Pregnancy Center.95 James Kopp, who in 2003 would be

convicted for the murder of physician and abortion provider Barnett Slepian, headed the

center.96 It was there that Abbotts watched the “Caring” slideshow which “presented

shocking pictures of large, bloody fetuses and misleading statistics and ‘horror’ stories

about abortion” while she waited for the results of her free pregnancy test.97 The suit,

which alleged multiple violations of the Business and Professions Codes prohibiting

“unlawful, unfair, or fraudulent business practices, and unfair, deceptive, untrue or

misleading advertising,” extended not only to A Free Pregnancy Center but also included

The Pearson Foundation who had provided the center with materials. As news of the suit

spread, other women who had sought the services of A Free Pregnancy Center began

reporting their experiences to the lawyers working for the Committee to Defend

Reproductive Rights, including one woman who had “been forced to go through an

unwanted pregnancy.”98 The suit was quickly followed by an investigation conducted by

the San Francisco District Attorney’s Office, which used the popular tactic of sending

95 The Superior Court of the State of California and for the City and County of San Francisco, No. 861193, Settled Statement (Pursuant to Rule 7 and Order), p 2, NOW LDEF Records, MC 623, Box 448, Folder Carla Abbotts Fake Clinics, 85-90, Schlesinger Library, Harvard University. I determined Abbotts’ race by contacting her attorney, Interview with Ann E. Menacshe by author, 3/4/14. 96 David Staba, “Doctor’s Killer Tries to Make Abortion the Issue,” New York Times, Jan 13, 2007. 97 Memorandum to NOW LDEF Defense Committee from Marsha Levick and Alison Wetherfield, April 1, 1986, p 2, MC 623, Box 448, Carla Abbotts Fake Clinics, 85-90, Schlesinger Library, Harvard University. 98 Ibid, p 1, MC 623, Box 448, Carla Abbotts Fake Clinics, 85-90, Schlesinger Library, Harvard University; The Superior Court of the State of California and for the City and County of San Francisco, No. 861193, Settled Statement (Pursuant to Rule 7 and Order), p 2, 3-4, NOW LDEF Records, MC 623, Box 448, Folder Carla Abbotts Fake Clinics, 85-90, Schlesinger Library, Harvard University.

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women posing as potentially pregnant to utilize the services at A Free Pregnancy

Center.99 The District Attorney filed a complaint on behalf of the People, and the two

suits were subsequently consolidated.100

As a result of the suit’s multiple defendants and representation by the state, the

judge’s ruling that the case did in fact constitute a violation of the California Business

and Professions Code barred not only A Free Pregnancy Center from a number of

practices but also prohibited the Pearson Foundation from aiding any anti-abortion

centers in the state.101 Assistant District Attorney David Moon, who had represented the

State in the case, celebrated the ruling stating, “What we’re hoping will be the impact is

that the Pearson Foundation will no longer be able to sell its deceptive approach in

CA.”102 For Pearson’s “Caring” slideshow this meant counselors had to read women a

disclaimer informing them of the low risks associated with abortion before showing the

film that would argue just the opposite.103

Throughout the case, Abbott’s feminist attorneys attempted to emphasize the

“intentional emotional distress” Abbott experienced while trying to obtain services from

A Free Pregnancy Center. The primary cause of such distress included the “Caring”

slideshow and accompanying counseling, which the attorneys described as “beyond the

99 The Superior Court of the State of California and for the City and County of San Francisco, No. 861193, Settled Statement (Pursuant to Rule 7 and Order), p 4, NOW LDEF Records, MC 623, Box 448, Folder Carla Abbotts Fake Clinics, 85-90, Schlesinger Library, Harvard University 100 The Court of Appeal of the State of California First Appellate District Division Two, AO46189, San Francisco Superior Court No. 854267, p 3, MC 623, Box 448, Folder Abbotts Repeal, 1991, Schlesinger Library, Harvard University. 101 Superior Court of the State of California in and for the City and County of San Francisco, Statement of Decision and Final Judgment, No. 854-267 (consolidated with No. 861-193), Feb 10, 1989, MC 623, Box 448, Folder Carla Abbots Fake Clinics 85-90, Schlesinger Library, Harvard University. 102 “Proposed Ruling would Prohibit Claims by Anti-Abortion Clinic,” LA Times, Dec 8 1988. 103 Superior Court of the State of California in and for the City and County of San Francisco, Statement of Decision and Final Judgment, No. 854-267 (consolidated with No. 861-193), Feb 10, 1989, p 10, MC 623, Box 448, Folder Carla Abbots Fake Clinics 85-90, Schlesinger Library, Harvard University.

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bounds of fairness and decency…designed to shock, horrify, frighten, vex, harass, injure

and upset all those who come to the center for pregnancy tests.” Proving the

intentionality of this emotional distress was the allegation that the defendants “aim their

services at unmarried women, knowing that these women are in an emotional state,

vulnerable, and sometimes easily influenced.”104 Similarly, feminist lawyers from the

National Organization for Women (NOW) who sought to provide legal support to the suit

highlighted the emotional distress caused by crisis pregnancy centers in hopes that the

case would “generate publicity about the dishonest and disgraceful activities of the pro-

life movement.”105

What the focus on “Caring” and Abbotts’ emotional vulnerability obscured was

how Abbotts, much like Friend, found herself at A Free Pregnancy center because of the

promise offered by its name. Abbotts was seeking a low-cost abortion, something the

center appeared to offer because of its description of “low-cost medical care.” Rather

than the vulnerability of being pregnant and unmarried, Abbotts’ primary vulnerability

was facing an unplanned, unwanted pregnancy without the adequate resources to pay for

an abortion. The additional contours of Abbotts’ situation—her poverty, her prior

abortions, and her brazen attitude towards the counselors she encountered—fell away in a

104 The first Cause of Action of the complaint brought on behalf of Abbotts was Unfair Business Practice as constituted by the Intentional Infliction of Emotional Distress, and the disregard of women’s welfare was repeatedly stated in the CCDR’s legal arguments. Superior Court of the State of California for the County of San Francisco, Case No. 854267, Complaint for Business and Professions Code, March 7 1986, p 1, 3, 5, MC 623, Box 448, Folder Carla Abbotts v. A Free Pregnancy Center Pleadings Vol 1, 1986, Schlesinger Library, Harvard University. 105 Memorandum to NOW LDEF Defense Committee from Marsha Levick and Alison Wetherfield, April 1, 1986, p 2, MC 623, Box 448, Carla Abbotts Fake Clinics, 85-90, Schlesinger Library, Harvard University. 105 Ibid, p 1, MC 623, Box 448, Carla Abbotts Fake Clinics, 85-90, Schlesinger Library, Harvard University.

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framework of anti-abortion deception and violence where pro-life activism rather than

structural inequality was positioned as the greatest threat to choice.106

Not everyone, however, was willing to assess the clinic deception as a threat to

choice. As evidenced by the numerous lawsuits and state investigations conducted during

this period, business codes of conduct and regulations for licensed medical practice were

the tools most often used against EPS centers.107 As such, discussions of deceptive

centers often centered on unethical business practices rather than a threat to choice. For

example, in 1991, the subcommittee on Regulation, Business Opportunities, and Energy

chaired by representative Ron Wyden met to discuss the “very troubling area of

consumer deception.”108 The hearings were meant to debate whether or not the Federal

Trade Commission could be used to stem the tide of this pro-life tactic, specifically by

amending the statute to include deceptive advertising practiced by non-profits. The

testimony, however, made sure to steer clear of the abortion debate. The two attorneys

general and one district attorney opened their statements with the caveats that the

morality of the pro-life position, the abortion question, and free speech were decidedly

not the topic of the hearings. Texas Assistant Attorney General Stephen Gardner even

went so far as to state “First and foremost, this is not an issue of abortion rights.” Instead

the three men’s opening testimony quickly became familiar: “We’re talking about fraud

106 In court documents, Abbotts admits to prior abortions, not being able to pay for her current abortion, and describes her willingness to challenge counselors’ suggestions. Declaration of Carla Abbotts, MC 623 Box 448, Carla Abbotts Fake Clinics, 85-90, Schlesinger Library, Harvard University. 107 I have been able to find one case that relied on a tort law to charge a crisis pregnancy center employee with intentional infliction of emotional distress. See Boes v. Deschu 768 S.W.2d 205. The attorney representing the plaintiff in this explained that emotional distress most directly reflected the harm she had experienced by visiting the center, Interview with Tom Mendelson by Author, 3/21/14. 108 “Consumer Protection and Patient Safety Issues Involving Bogus Clinics,” Hearing before the Subcommittee on Regulation, Business Opportunities, and Energy, Committee on Small Business, One Hundred Second Congress, Sept 20, 1991, p 1.

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and deception; it is a simple case of deception; the issue, as you have very clearly

articulated here today, is deliberate and calculated deception.”109

Despite their differences, the two approaches—of feminist lawyers emphasizing

emotional distress and the threat to choice and state and federal representatives

emphasizing ethical business practices—ultimately worked together to obscure the

disproportionate threat centers posed to poor and low-income women. As a result, the

EPS centers not influenced by Pearson, particularly the ones being quietly cultivated by

CAC during this period, would continue gaining ground as advocates for pregnant

women in need. The peak of the volatile abortion debate—clinic blockades orchestrated

by Operation Rescue—would continue to obscure this fact.

Warna Lewis and Alexandria v. Bray

In the late 1980s and early 1990s, women’s rights organizations such as NOW

attempted to identify a legal strategy that would stop clinic blockades organized by

Operation Rescue and the Pro-Life Action League. Silence on the part of the Reagan and

Bush administrations regarding the activities of pro-lifers whose protests made it

physically impossible for women to enter clinics left advocates with little hope for federal

intervention. Instead, they turned to the courts and appealed to a number of different laws

in hopes that one would find these demonstrations illegal. The all-consuming nature of

these legal battles ensured that pro-choice advocates were focused on protecting existing

access to abortion. The case of Warna Lewis, a woman whose suit against an EPS center

109 Ibid, p 17, 21-22, 26.

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in Missouri became tied to the fate of feminists pursuing Operation Rescue, further

illustrates the ways the EPS movement was attributed to anti-abortion radicalism.

Around the same time Carla Abbotts visited A Free Pregnancy Clinic in San

Francisco, Warna Lewis, a Black woman living in East St. Louis, found the AAA

Pregnancy Problem Center listed in the yellow pages under “Abortion Information and

Services.”110 Lewis, mother to an eighteen month-old daughter and pregnant, had

decided abortion was the only way for her and her daughter to escape an abusive

boyfriend. At the clinic in Bridgeton, Missouri, Lewis was given a pregnancy test before

being shown the “Caring” slideshow. After going through with her plans for abortion a

week after her visit to AAA Pregnancy Problem Center, Lewis sought help from the

American Civil Liberties Union (ACLU) and sued the Pearson Foundation.111

Unlike the attorneys general in Texas and New York who testified before

Congress, Missouri Attorney General William Webster did not consider EPS centers to

be involved in deceptive advertising and as a result refused to use state business code

statutes to reign in center practices on behalf of women’s consumer right to abortion.112

Webster, of Webster v. Reproductive Health Services fame, had upheld laws limiting

access to abortion that made Missouri the first state to successfully enact restrictions with

regards to the procedure, making him beloved by pro-lifers across the country.113 As a

110 Interview with Tom Mendelson, Lewis’ lawyer, by author, 3/21/14. 111 Lewis reported that the “Caring” slideshow included “dismembered fetuses piled in buckets,” something that was especially upsetting due to the fact that it brought back memories of an abortion she had received at 17 after being raped. William H. Freivogel, “Supreme Court Shuts Door on Suit Against Fake Clinic,” St. Louis Post-Dispatch, Jan 14, 1993. Kathleen Best, “Court Rejects Case of Ruse on Abortion; Mislead by Phony Clinic, Cahokia Woman Says,” St. Louis Post-Dispatch, Feb 23, 1993. 112 Folkers, Scott, “Lewis v. Pearson Foundation, Inc.: Does 42 U.S.C. § 1985(3) Offer Protection to Women as a Class?” South Dakota Law Review, Vol 37, 1992, p 624. 113 Webster was the chief defendant in the Supreme Court case. “Ex-Official Admits Fraud in Missouri,” NYT, June 3, 1993.

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result of Webster’s political sympathies, the deception route that had been so successful

in other states was unavailable to Lewis.

Instead, Lewis and her attorney Tom Mendelson turned to a nineteenth-century

law designed to protect newly freed slaves from mob violence committed by the Ku Klux

Klan. The Ku Klux Klan Act of 1871 was designed to make it more difficult for private

groups to violate civil rights and gave state governments the authority to intervene in

these private affairs. The section Lewis called upon, section 1985(3), encompassed “any

private conspiracy which has a discriminatory animus based on a person’s membership in

any class, and which deprives that person of the equal enjoyment of any right or privilege

generally secured to a United States Citizen.”114

In the case of Lewis, the rights being deprived by the operations of the Pearson

Foundation and the AAA Pregnancy Problem Center included those afforded her by Roe

v. Wade and the Fourteenth Amendment—“privacy, autonomy, personhood, and liberty

in exercising a choice as to the continuation or discontinuation of a pregnancy.”115 While

Pearson and AAA constituted the “private conspiracy,” Attorney General Webster was

accused of granting support to the group through his failure to use available state statutes

to combat deceptive advertising. Lewis claimed that these actions unfairly discriminated

against the class of “pregnant women desiring to terminate their pregnancies,” a class of

which she was a part. In addition to the violation of her rights granted by the Fourteenth

114 Folkers, Scott, “Lewis v. Pearson Foundation, Inc.: Does 42 U.S.C. § 1985(3) Offer Protection to Women as a Class?” South Dakota Law Review, Vol. 37, 1992, p 625-626. 115 Hansen, Beth, “ ‘Invidiously Discriminatory Animus’—A Class Based on Gender and Gestation Under 42 U.S.C. § 1985(3): Lewis v. Pearson Foundation, Inc.,” Creighton Law Review, Vol. 24, 1991, p 1099.

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Amendment, Lewis described her injury as “mental distress, torment, anguish, morbid

recall, sadness, embarrassment, humiliation, and anger.”116

The District Court for the Eastern District of Missouri dismissed Lewis’

complaint on the grounds that section 1985(3) was not intended to protect pregnant

women seeking to terminate a pregnancy and found that the class EPS centers were

allegedly targeting was not a class at all.117 Lewis appealed the decision and the Court of

Appeals for the Eighth Circuit, after vacating the lower court’s decision and rehearing the

case, affirmed the original decision by way of a tie vote. Lewis appealed the decision to

the Supreme Court.

While Lewis’ case was making its way up the courts, Operation Rescue had

chosen November of 1989 to focus its energies on abortion clinics in the Washington

Metropolitan area, which meant that clinics in D.C., Virginia, and Maryland were at risk

of being shut down for hours on end while hundreds of rescuers made it physically

impossible for anyone to enter the facilities. Having learned of the group’s plans, clinics

in all three states obtained a temporary injunction against the demonstrations. They did so

using Section 1985(3) of the Klu Klux Klan Act and argued that Operation Rescue’s

clinic blockades interfered with women’s right to interstate travel, as many of the women

came to the clinics from out of state, and therefore the blockades amounted to

discrimination against women.118

116 Ibid, 1100. 117 The defendants argued that Lewis failed to state a claim on three different counts. In addition to the failure of pregnant women seeking an abortion constituting a class, the defendants argued that evidence of violation of the 14th amendment required state action (as opposed to only action of a private group) and that the complaint was not specific enough with regards to the actions of each individual defendant. Yet the court dismissed Lewis’s complaint based only on the class based count. Lewis, No. 87-894 c(2). 118 Greenhouse, Linda. “Consequential Cases are Likely to Test the Supreme Court’s New Majority,” NYT, Oct 7 1991, A14.

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The Metropolitan Area was no stranger to the faction of the pro-life movement

that favored more confrontational tactics, and such familiarity no doubt contributed to the

courts’ favorable ruling. Just four years prior to the injunction, bombings at ten health

clinics and abortion rights organizations occurred over the course of a year in Maryland,

Virginia, Delaware, and the District. While there were no injuries, the attacks resulted in

over one million dollars in damages. Michael Bray of Prince George County pled not

guilty, but was arrested and spent four years in federal prison for the bombings, making

Bray a “prisoner of conscience” within certain pro-life circles. 119 Shortly after his return

home, his wife took the pro-life spotlight as a dedicated “rescuer.” When Operation

Rescue appealed the District Court’s injunction, Bray became the lead plaintiff for the

Supreme Court case, solidifying her and her husband’s place as the “most radical anti-

abortion activists in the Washington area.”120

The Supreme Court heard Bray v. Alexandria Women’s Health Clinic on October

7, 1991, and Warna Lewis’ fate became tied to women who had been barred access to

abortion through a different pro-life tactic.121 In a 6-3 decision, the Supreme Court

rejected respondents’ claim that Operation Rescue’s clinic blockades deprived women of

119 Pressley, Sue Anne, “From Prison back to P.G. Pulpit: Clinic Bombings Led to Sentence,” The Washington Post, Jul 26, 1989, B1. 120 Naughton, Jim, “Faces of 2 Antiabortionists; A ‘Pretty Normal’ Life Contrasts with Confrontational Stand,” The Washington Post, Dec 3, 1991. This District Court was not alone in its agreement that clinic demonstrations violated the Ku Klux Klan Act, nor was it the first time Operation Rescue attempted to appeal the ruling to the Supreme Court. New York’s Federal Court issued a permanent ban on blockading clinic entrances using the Act in 1990, and that same year the Supreme Court refused to hear an appeal. See Lewin, Tamar, “With Thin Staff and Thick Debt, Anti-Abortion Group Faces Struggle: Blocking Clinic Doors has led…,” NYT, Jun 11, 1990, A16. 121 Bray v. Alexandria Women’s Health Services was originally National Organization for Women v. Operation Rescue, which brought the original injunction in 1989. Both the District Court and the Court of Appeals for the Fourth Circuit affirmed the injunction, causing Operation Rescue to appeal to the Supreme Court. See Leheny F. Mary, “A Question of Class: Does 42 U.S.C. Section 1985(30 Protect Women Who Are Barred From Abortion Clinics,” Fordham Lew Review, Vol 60, 715, March 1992.

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their constitutional right to interstate travel, privacy, or abortion.122 While the majority

opinion had concerns about federal overreach and protections from private parties

afforded by constitutional rights, the major issue was whether or not women constituted a

distinct class and, therefore, if opposing abortion constituted “invidiously discriminatory

animus” towards women. Rejecting the District Court’s original ruling, Justice Scalia

writing for the majority stated “whatever may be the precise meaning of ‘class’ for

speculative extension of section 1985(3) beyond race, the term unquestionably connotes

something more than a group of individuals who share a desire to engage in conduct that

the section 1985(3) defendant disfavors.”123 Even broadening beyond the “conduct” of

seeking an abortion to assert that women as a whole constituted a class did not sway the

Court due to the fact that Operation Rescue “defines their ‘rescues’ not with reference to

women, but as physical intervention ‘between abortionists and the innocent victims.’”

Further separating gender from the abortion question, Scalia concluded, “Whatever one

thinks of abortion, it cannot be denied that there are common and respectable reasons for

opposing it, other than hatred of, or condescension toward (or indeed any view at all

concerning) women as a class—as is evident from the fact that men and women are on

both sides of the issue, just as men and women are on both sides of petitioners’ unlawful

demonstrations.”124

122 Bray v. Alexandria Women’s Health Clinic 506 U.S. 263 (1993). 123 Ibid, 269. 124 Ibid, 271. This aspect of the ruling greatly mirrored the arguments made in the Amicus Brief submitted by Feminists For Life. Calling respondents’ claim that blockades constituted animus against women “absurd,” FFL also somewhat confused the gender-based discrimination claim arguing “opposition to abortion is not a gender-specific trait” and that “the activity engaged in by the petitioners does not convert their gender-neutral opposition to abortion into action representative of class-based animus” at the same time that they cited the growing numbers of American women in opposition to abortion. See Brief of Feminists for Life of America et al as Amici Curiae in Support of Petitioners. Dissenting, Justice Stevens cast Operation Rescue not as “section 1985(3) defendants” disfavoring abortion, but as “a striking contemporary example of the kind of zealous, politically motivated, lawless conduct that led to the

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Months later, the Supreme Court issued the expected decision that they would not

hear Warna Lewis’ case regarding the Bridgeton AAA Pregnancy Problem Center. With

a new attorney general in place in Missouri, Lewis hoped to try once again the route of

deceptive advertising that had proven so convincing in California, New York, and

Texas.125 Warna Lewis’ defeat went largely unnoticed by pro-choice organizations whose

attentions would continue to be consumed by the seemingly endless supply of “rescuers.”

Despite their best efforts, those fighting to defend choice would not win over the

conservative Supreme Court that took shape during the same period that anti-abortion

violence reached its apex.126

Lewis’ story is important for a number of reasons. First, it shows how

conservative courts thoroughly rejected the legal strategy of positioning abortion access

as a uniquely gendered right. Second, it shows how battles between pro-choice

organizations and Operation Rescue literally subsumed other histories of pro-life

enactment of the Ku Klux Act in 1871 and gave it its name.” Stevens also rejected the majority’s logic that conveniently removed women from the abortion equation, writing that “to satisfy the class-based animus requirement of section 1985(3), the conspirators’ conduct need not be motivated by hostility toward individual women. As women are unquestionably a protected class, that requirement—as well as the central purpose of the statute—is satisfied if the conspiracy is aimed at conduct that only members of the protected class have the capacity to perform. It is not necessary that the intended effect upon women be the sole purpose of the conspiracy.” Putting an even finer point on it, he stated, “When such animus defends itself as opposition to conduct that a given class engages in exclusively or predominantly, we can readily unmask it as the intent to discriminate the class itself.” See Bray v. Alexandria Women’s Health Clinic 506 U.S. 263 (1993), 313, 320-323. 125 Best, Kathleen, “Court Rejects Case of Ruse on Abortion; Misled by Phony Clinic, Cahokia Woman Says,” St. Louis Post-Dispatch, Feb 23, 1993, 1A. 126 Long before the Bray case made its way to the Supreme Court, N.O.W. had set its sights on Joseph Scheidler, national director of the Pro-Life Action League and mentor to Terry Randall of Operation Rescue. In what would become a 19-year legal battle, N.O.W. attempted to prosecute Scheilder and his organization using the Racketeer Influenced and Corrupt Organizations Act, attempting to define anti-abortion direct action tactics as racketeering. In 2006, the Supreme Court ruled in favor of Scheidler. See Scheidler v. National Organization for Women 547 U.S. 9 (2006). While scholars have pointed out the galvanizing effects more confrontational pro-life tactics had on the pro-choice movement, legal victories at the level of the Supreme Court were unlikely due to the increasingly conservative makeup of the court, as well as White House support for groups like Operation Rescue during the Bush Administration. See Ginsburg, Faye, “Saving America’s Souls: Operation Rescue’s Crusade against Abortion” in Fundamentalisms and the State: Remaking Polities, Economies, and Militance, Ed by Martin E. Marty and R. Scott Appleby, University of Chicago Press, 1993.

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coercion. Third, it reveals how access in a threat-to-choice framework left no room for

acknowledging class. The fact that EPS centers offered free services did not become a

part of the debate. As such, Lewis’ particular circumstances fell away as “bogus clinics”

became yet another example of the lengths pro-lifers would go to stop abortion.

Conclusion

When abortion provider David Gunn was murdered in 1993, the Vice President of

CAC Gary Thomas saw an opportunity in the tragedy. “For 20 years, pro-life [sic] said

what its [sic] against,” said Thomas. “We want to say what we’re for: caring for women,

for unborn children…We think through improving our alternatives, we can save a lot of

women from abortion regardless of what the law is.”127 Not Pearson, nor AAI, nor the

Kennedy Foundation claimed the mantle of alternatives to abortion in the 1990s. Instead,

the majority Evangelical CAC would emerge as the leader in advocating a service-based

approach to legal abortion. As CAC was increasing its centers throughout the 1980s, it

may have also been learning from Pearson’s mistakes. A year before Thomas weighed in

on Gunn’s death, another CAC representative penned an editorial in the Wall St. Journal

that favorably compared the unsung workers who “toil in the confidential environment of

one-to-one counseling” to the “highly visible pro-life activities of Operation Rescue.”128

CAC’s extensive rebranding efforts would ultimately ensure that the service-based

approach to abortion overcame the tumultuous 1980s.129

127 “Bowed, but Unbroken?” LA Times, 22 March 1993, Lynn Smith. 128 Diemert, Beth, “Supporting Her Choice When it Isn’t Abortion,” Wall Street Journal, Jan 22, 1992, A14. 129 I address the movement’s rebranding strategy in Chapter Four.

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Just as Faye Wattleton and others linked EPS centers to anti-abortion radicalism

in the late 1980s, contemporary pro-choice materials on crisis pregnancy centers continue

to attribute the start of the movement to the Pearson Foundation.130 In other words, the

early history of the EPS movement remains obscured to this day. In this chapter, I have

attempted to show how that happened. The dismissal of anything but a legislative strategy

immediately after Roe ensured AAI’s marginalization despite its best efforts. Later in the

decade, AAI’s own strict stance on abortion limited its ability to gain legitimacy by way

of governmental collaboration. By the 1980s, Pearson’s unabashedly confrontational and

coercive tactics were easily seen as additional evidence of anti-abortion radicalism that

took the abortion debate out of Congress and into the streets. In some ways, the “Caring”

slideshow was precisely what pro-choice advocates said it was. But what Pearson’s

tactics and a threat-to-choice framework covered up was something different. The initial

idea behind EPS services—that women facing an unplanned pregnancy lacked emotional

and material support—remained a fact despite the tactics a given center might employ.

EPS services are significant because they operate on a politics of need, but they are

consistently read through a politics of choice. While the women who brought lawsuits

against centers in the 1980s were in need of abortion, the lure of free services that EPS

used to capitalize on this need was lost in a threat-to-choice frame. While this frame

largely affected women seeking abortions during the 1980s, it has also affected pregnant

women seeking support from EPS centers.

130 See for example “Crisis Pregnancy Centers: An Affront to Choice,” National Abortion Federation, 2006, p. 1.

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CHAPTER TWO

Navigating “Risk”: Women, AIDS, and the Politics of Reproduction, 1980-1995

Introduction

In 1987, six years after the first case of AIDS had been officially reported by the

Centers for Disease Control (CDC), journalist Chris Norwood published Advice for Life:

A Woman’s Guide to AIDS Risk and Prevention. A National Women’s Health Network

Guide, the book aimed to provide women with accurate information about risk of

infection because “health officials throughout the country have had trouble talking

directly and honestly to women about Aids [sic].”131 Despite comprising some of the

earliest cases reported, women still had not been designated a risk group by the CDC.132

This was due in part to the immediate construction of the illness as a “gay disease” and

the higher incidence rates in men. But it was also willful ignorance regarding the

possibility of heterosexual transmission and sexism within biomedicine that constructed

women as infectious agents as opposed to infected individuals in need of treatment.

Having spent years reporting on women and AIDS, Norwood expressed her outrage and

sense of urgency: “When the history of Aids [sic] in the United States is finally written, it

may be remembered above all that women were deceived.”133

131 Chris Norwood, Advice for Life: A Woman’s Guide to AIDS Risk and Prevention, New York: Pantheon, 1987, p. 7. 132 In the CDC’s first year update on the disease, 5.1% of the 693 total reported cases were among women CDC (1982e). For an in-depth analysis of how women were consistently obfuscated in the epidemiological categories published in the Morbidity and Mortality Weekly Report (MMWR) see Paula A. Treichler, How to Have Theory in an Epidemic: Cultural Chronicles of AIDS, Durham: Duke University Press, 1999, p. 48-59. 133 Norwood thought capitalizing AIDS only reinforced people’s fear of the disease. Norwood, Advice for Life, p. 3.

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A little over five years later, Cindy Patton published a very different kind of book

about women and AIDS.134 Rather than a compilation of “current knowledge about

women’s situation in the HIV pandemic,” which aptly described Advice for Life, Patton

offered an analysis of the ways ideas about gender had influenced media and policy

responses to the epidemic. Last Served? went against the common refrain that women

had been overlooked in public responses to HIV/AIDS, resulting in an “invisible” or

“silent” epidemic. Instead, Patton outlined the ways that women were constructed as

infectious agents, whether they be prostitutes, mothers, intravenous drug users, or

vengeful individuals intent on infecting as many men as possible.135 Arguing that women

seemed to matter only as “vectors of disease,” Patton bluntly asserted, “When women are

not vaginas waiting to infect men, they are uteruses waiting to infect fetuses.”136

During the first years of the epidemic and into the peak of the direct-action AIDS

movement, women and AIDS advocates criticized both women’s invisibility and the

tendency to see women as infectious threats rather than victims in their own right. They

did so in an effort to influence municipal and federal level responses to the disease. There

134 Cindy Patton, Last Served? Gendering the HIV Pandemic, United Kingdom: Taylor and Francis, 1994. 135 Ibid, p. 4. Patton is not the only scholar to show how the category of “woman” constantly shifted to simultaneously alleviate and heighten anxieties not only about the spread of infection, but also drug use, race, and poverty. See Hammonds, Evelyn, “Missing Persons: African American Women, AIDS, and the History of the Disease” Radical America 24(2), 1992, 7-23, “Toward a Genealogy of Black Female Sexuality: The Problematic of Silence,” In Feminist Genealogies, Colonial Legacies, Democratic Futures, eds. Alexander, M. Jacqui and Chandra Talpade Mohanty, 1997, 170-182, New York: Routledge; Patton, Cindy, Last Served? Gendering the HIV Pandemic, United Kingdom: Taylor and Francis, 1994; Waldby, Catherine, AIDS and the Body Politic: Biomedicine and Sexual Difference, London: Routledge, 1996; Goldstein, Nancy and Jennifer L. Manlowe, eds. 1997. The Gender Politics of HIV/AIDS in Women: Perspectives on the Pandemic in the United States. New York: New York University Press; Treichler, Paula A, How to Have Theory in an Epidemic: Cultural Chronicles of AIDS, Durham: Duke University Press, 1999. Oftentimes, advocacy groups appealed to both formulations. For example, AIDS Coalition to Unleash Power (ACT UP) popularized the slogans “Women Don’t Get AIDS, They Just Die From It” and “Women Cannot Wait ‘til Later, We Are Not Your Incubators” which communicate the two different positions outlined here. 136 Cindy Patton, Last Served? Gendering the HIV Pandemic, United Kingdom: Taylor and Francis, 1994, p. 109.

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was no shortage of failings to point out: social service responses, prevention and

education materials, and treatment protocols typically failed to account for women. In

addition to lobbying and pressuring health officials, many of the groups committed to

women and AIDS took on the work of researching the disease, creating educational

materials, and even providing social services to HIV-positive women and women with

AIDS.

In this chapter, I examine advocacy efforts that attempted to push women’s needs

to the forefront of debates over the AIDS epidemic. While AIDS was not considered a

women’s health issue until well into the 1990s, women and AIDS projects in cities like

San Francisco, New York City, Los Angeles, and Chicago formed early on in the

epidemic to address what they considered women’s exclusion from medical, public

health, and social service discussions about the disease. Often comprised of women

working in the medical and social service fields, these projects were motivated by

concern for the women they knew to be sick but were going unrecognized and unaided

due to epidemiological and popular accounts that proclaimed women to be free of risk. I

examine women and AIDS projects in San Francisco and New York City and highlight

the vital role they played as clearinghouses of information during a period when facts

about the epidemic’s impact on women were hard to come by. I then turn to women and

AIDS advocates who were a part of the direct action AIDS movement during the late

1980s and early 1990s. These women set their sights on making the Food and Drug

Administration (FDA) change the way it handled women’s participation in experimental

drug testing.

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While largely distinct, early women and AIDS projects and woman-centered

direct-action AIDS activism were united by a belief that women’s reproductive needs—

social as well as biological—must be at the forefront of responses designed to serve

women. Women and AIDS projects consistently emphasized women’s caretaking

responsibilities and argued that social services such as drug treatment programs be able to

accommodate women with children. Advocates taking on the FDA rejected the logic that

women made for poor trial participants because of their procreative capacity and pushed

for an overhaul of experimental drug testing that would resolve reproductive risk.

Accounts offered by Patton and others highlight the ways women’s bodies—particularly

their capacity for pregnancy—were often seen as sites of contagion that, if properly

controlled, could temper rates of infection. What is less well known are the ways women

and AIDS advocates also made reproduction central to the epidemic, not as a separate

issue to be cordoned off, but as a necessary and fundamental aspect of women’s lives that

effective responses would have to address.

The battle between women and AIDS advocates and the FDA is a particularly

important example of one of Reconceived’s major arguments—that the ability to prevent

pregnancy and motherhood undermined demands aimed at accommodating women’s

procreative capacity. The clinical trials debate is also an important example of the ways

women and AIDS advocates’ distinct positions on effective treatment protocols struggled

for recognition in the shadow of more familiar notions of women’s rights on the one hand

and AIDS activism on the other. Working at the intersection of these two movements,

women and AIDS advocates struggled to stake their own ground. As this chapter

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illustrates, their distinct take on women’s reproduction and experimental drug testing has

largely been misread in the literature as a result.

Fighting for Access to “Risk”

In Impure Science: Aids, Activism, and the Politics of Knowledge, sociologist

Steven Epstein argues, “From the start—and up to the present day—AIDS has been

understood both in epidemiological and lay parlance as a disease of certain already-

constituted social groups distinguished by their ‘lifestyle,’ their social location, or both.

The result is that the very meaning of AIDS has been bound up with the cultural

understanding of what such groups are like, while the very identity of the groups has been

shaped by the perception of them as ‘the sort of people who get this illness.’”137 Epstein’s

formulation illustrates the complex challenge confronting early women and AIDS

advocates. As a result of the illness overwhelmingly afflicting gay men, the

epidemiological and public health response conflated sexual behavior with sexual

identity, a conflation reflected in officially designated “risk groups”. This foundational

logic continued even as it became clear the disease could be transmitted in other ways

and as new risk groups, including intravenous drug users and hemophiliacs, were

identified by the Center for Disease Control (CDC).

While Epstein’s point is that dominant “cultural understandings” of certain groups

and the stigma of AIDS produced mutually reinforcing, largely negative ideas about what

people who got AIDS were like, women confronted an even more immediate problem

than stigma—they were nowhere to be found in epidemiological or cultural accounts of

137 Steven Epstein, Impure Science: AIDS, Activism, and the Politics of Knowledge, University of California Press, 1996, p. 11.

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“people who get this illness.” As Paula Treichler has meticulously documented, this was

not for a lack of official reports of symptomatic women. In the CDC’s Morbidity and

Mortality Weekly Report’s (MMWR) one-year update on the epidemic, heterosexual

women were listed as comprising 34 of the 355 received reports. Yet this specific

designation was short lived, as the category of woman became subsumed under

subsequently created categories such as “previously healthy persons,” “Haitians,” or

“intravenous drug users.”138 Because so little was known about the disease during the

early years of the epidemic, official CDC designated risk groups held enormous

significance. They (misleadingly) communicated who needed to be worried about getting

sick and who did not. For nearly the first ten years of the epidemic, CDC risk group

categories obfuscated the reality of transmission routes by appearing to cordon off

heterosexual men and women from risk.139

Early women and AIDS projects, then, were primarily concerned with

establishing women’s vulnerability to the disease far more than they were interested in

challenging the logic of indexing risk through identity rather than transmission routes.

Yet when the Women’s AIDS Network (WAN) formed in San Francisco in 1983, it was

not immediately apparent to members just how overwhelming this task would be. Many

of the founding members were involved in political, medical, or social service AIDS

work in San Francisco, and professionals affiliated with the San Francisco AIDS

Foundation, the San Francisco Department of Health, San Francisco General Hospital,

and the University of California San Francisco Medical Center made up a significant

138 Treichler, How to Have Theory in an Epidemic, p. 49-50, 58. 139 Ibid, p. 55-57.

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portion of the membership. 140 The women who came together to found WAN envisioned

it more as a resource for professionals working in AIDS services and interested in how

the epidemic was affecting women than as a direct support or service group for women

with AIDS. It is possible that San Francisco’s low numbers of reported AIDS cases in

women, as compared to gay men and male IV drug users, tempered the initial vision of

WAN. While the rate at which female cases of AIDS were being reported in New York

City—having doubled every year since 1982 by 1986—no doubt served to remind WAN

of the possibility that there could be an explosion of infection in women, upon forming in

1983 the low numbers of women with AIDS in San Francisco most likely reinforced the

sense that the organization would serve primarily as a professional network serving AIDS

workers rather than women with AIDS. 141

But as news of WAN spread, it became clear that the primary need was accurate

information on women and risk. By 1985, the network was being flooded with requests

for information about women and AIDS from all over the country.142 While one of the

first projects WAN took on was compiling a referral manual of Bay Area services, it

quickly turned its attention to creating informational brochures on “Women and AIDS”

and “Lesbians and AIDS” with sections such as “Am I at Risk?,” “Assessing Risk,” and

“Risk Reduction Guidelines.”143 By the end of 1986 WAN’s “Women and AIDS”

140 WAN Minutes 3/4/86, p. 3, Folder “Minutes: Feb-March, May-Sept, 1986,” Carton 1 of 1, WAN Records. 141 WAN’s meeting notes often include documents reporting New York City’s statistics (220, 1029). By 1986, women comprised 10% of AIDS cases in New York City, having doubled every year since 1982. “Women and AIDS in New York City” by Dooley Worth and Don Lorimer, June 1986, WAN Minutes: Feb-March, May-Sept, 1986 Folder, Carton 1 of 1, Wan Records. 142 (129) WAN Meeting Minutes, 7/2/85, Folder “WAN Minutes: Feb-Oct, Dec, 1985,” Carton 1 of 1, WAN Records. 143 By 1985, WAN had already published the second edition of its referral manual. “Women and AIDS: A Referral Manual for Women with Concerns about AIDS,” October 1985, Second Edition, Folder “Minutes-

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brochure was the San Francisco AIDS Foundation top selling educational item, and the

organization boasted of membership in thirty states and six countries.144

In short order, then, WAN became intimately involved in the politics of service

provision for women with AIDS despite its intentions of serving as a clearinghouse for

information. At a June meeting in 1986, upon learning that three more women in San

Francisco had been diagnosed with AIDS, WAN discussed the lack of services for

women with children. “There is no place for a woman with a drug problem, with kids,

with or without AIDS or positive anti-body status to go in this city.”145 Upon reaching out

to one of the major AIDS services organizations about designating one of its residences

for women with children, a WAN representative was told, “children would have too

much energy and be too difficult to live with.”146 WAN also learned of women negatively

affected by the San Francisco Department of Health’s guidelines for care of HIV positive

children, which directed public daycare providers to keep these children out of group

settings.147 When invited by the San Francisco Department of Health to submit a

proposal outlining “needed AIDS-related services for women,” WAN prioritized

educational outreach to inform women of accurate risks for infection and a residential

program for women with AIDS who had children.148 For a number of years, WAN would

bring this issue to the Department of Health and the major AIDS organization that

January, 1986,” Carton 1 of 1, WAN Records; “Lesbian and AIDS Brochure—Draft,” n.d., Folder, “Minutes: Feb-March, May Sept, 1986,” Carton 1 of 1, WAN Records. 144 (523) Folder “Minutes: July, 1987”, Carton 1 of 1, WAN Records; (6) Folder “Strategizing, Structure”—founding and review of purpose, 1984-88, 1990, Carton 1 of 1, WAN Records. 145 WAN Meeting Minutes, June 3, 1986, Folder “Minutes: Feb-March; May-Sept, 1986,” Carton 1 of 1, WAN Records. 146 Ibid. 147 WAN Meeting Minutes, Jan 6, 1987, Folder “Minutes: January, 1987,” Carton 1 of 1, WAN Records. 148 Proposal from WAN to AIDS Activity Office, SF Department of Health, October 1986, Folder “Minutes: October, 1986,” Carton 1 of 1, WAN Records.

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provided residency to a predominately male population. Eventually, the organization

collaborated with WAN in pressing the Department of Health to provide family-friendly

residential opportunities, but very little progress was made to address this gap in service

provision.

WAN’s broadly stated aim of serving as a support network for professionals

working in AIDS services combined with the increasing need for services amongst

women with AIDS pulled the organization in a number of directions. In addition to

producing its own educational materials, the organization attempted to respond to

education, outreach, and service needs, repressive legislation, and anecdotal reports of

women unable to get the help they needed. 149 As a result, the organization struggled to

see its many ambitious initiatives through and was often taking stock of its major

priorities. Such difficulties were as much an issue of organization as an inevitable

consequence of trying to respond to all of the service needs articulated by women with

AIDS, many of which resulted from inequalities compounded by illness.

For example, in February of 1990 WAN held info sessions for women living with

HIV and AIDS as well as service providers in an effort to identify the greatest challenges

facing women. The transcript from one of the sessions reveals how the epidemic was

larger than the disease itself, making visible and exacerbating entrenched social

inequalities along lines of race, class, and gender, inequalities public health responses to

AIDS largely failed to account for as a result of seeing the disease in isolation. One

woman reported, “I’m a long-term AIDS survivor since 1982 and I’ve seen few changes

149 (155) Folder “ WAN Minutes: January, 1986, Carton 1 of 1 WAN Records. (395) Folder “WAN Minutes: April, 1987”, Carton 1 of 1, WAN Records. (277) Folder “WAN Minutes: November, 1986”, Carton 1 of 1, WAN Records. (203) Folder “Minutes: Feb-March, May-Sept, 1986,” Carton 1 of 1, WAN Records.

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since then. We need basic thing like childcare. I needed an egg crate mattress but I didn’t

have $30. I have a 10 month grandson to take care of and some days I’m too sick to take

care of him.” Another said, “The reality is we already have support groups. We need

money. I don’t have money for my daughter’s needs. If you put a catastrophic illness on

women who are on welfare, you get a crisis.”150 In response to the repeated expressions

of poverty and economic stress, WAN decided to create an Emergency Fund to be

distributed to women with AIDS, granting women in need $50 checks. The organization

continued to stretch itself to respond to the various issues raised by the epidemic.

In New York, women working in social service provision, who were seeing their

clients become ill, also came together to discuss how the epidemic was affecting women

and children. In 1986, the Women and AIDS Project (WAP) was formed with

sponsorship from the New York State Division for Women and the New York State

Division of Substance Abuse Services. In their first newsletter detailing the group’s

formation, WAP reported, “We also discussed the needs of AIDS victims (particularly

minority victims) and what we could do to help those women and children whose lives

have been so disastrously affected by AIDS and ARC…It became painfully clear that we

were all operating in nearly total isolation.”151 Early meetings consisting largely of

service providers in New York and New Jersey agreed that the epidemic “had not been

addressed sufficiently from a woman’s perspective, especially from the perspective of

women of color.”152

150 WAN Meeting Minutes, February 5, 1990, Folder, “Minutes: Jan-Dec, 1991,” Carton 1 of 1, WAN Records. 151 Untitled newsletter 2/1/87, p. 2, Linda Loffredo Personal Papers. 152 “AIDS: Its Impact on Women, Children, and Families, Summary of Testimony,” June 12, 1987, p. 1, Linda Loffredo Personal Papers.

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Members of WAP went to work creating a network that facilitated “government-

constituent interaction, communication, and cooperation.”153 In addition to a bi-monthly

newsletter that compiled research, referrals, and agency updates related to women and

AIDS, WAP organized monthly seminars examining various aspects of the AIDS

epidemic from a “woman’s perspective.” Being located in New York City meant there

was no shortage of experts to draw from, and seminars ranged from increasing women’s

access to clinical trials to spiritual wellness to youth outreach.154 These seminars were as

much networking opportunities as they were educational, and WAP’s connection to New

York State agencies meant service providers and advocates had greater access to

government officials that would have had otherwise. These connections also extended to

well-funded and powerful women’s organizations and foundations that had been slow to

embrace the epidemic as an issue. Calling it “leadership development,” WAP facilitated

the creation of a “coalition of women from prominent NYC-based

organizations…designed to encourage main stream women’s organizations, women

elected to public office and women in the media and the arts to become involved with the

women and AIDS issue.”155

In short, WAP used its access to various networks to put women on the map when

it came to discussions of the epidemic. As it did this, it prioritized the experiences of

women of color with HIV and AIDs as well as women who performed the bulk of the

caretaking of sick individuals. A year after its formation, WAP was instrumental in

holding public hearings on the impact of the epidemic on women, children, and families.

153 “The Women and AIDS Project: A Model for Government-Constituent Interaction,” n.d., Linda Loffredo Personal Papers. 154 Examples taken from WAP newsletter Spring 1989, p. 2, Linda Loffredo Personal Papers. 155 “Women and AIDS Project,” p. 32, January 1990, Linda Loffredo Personal Papers.

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Among its many recommendations, it suggested that “AIDS education, prevention,

outreach, health care, and social service programs for women and children should be

designed by women who are members of the targeted communities with the assistance of

appropriate state and local government staffs.”156 Fundamental to this philosophy was the

view that the epidemic exacerbated already existing inequalities felt most directly by poor

women of color with children. By making women visible, those testifying at the public

hearings attempted to counter responses to the epidemic that both treated the disease in

isolation and minimized the number of populations truly at risk. A representative of a

substance abuse program in New York City testified, “Women are an unacknowledged

risk group and, for the most part, women are uninformed of the danger to themselves and

their children. On the whole, few women are taking precautions to prevent AIDS.

Women may have to negotiate with far less cooperative sex partners…most articles on

safer sex practices do not explain in any depth the social difficulties women many

encounter in trying to persuade their sex partners to use condoms.”157

Yet while those at the public hearings generally agreed that inequalities across

race, class, and gender were exacerbated by the disease and unaccounted for in

prevention and social services, increasing women’s visibility had to be balanced against

the multiple vulnerabilities that made speaking out dangerous. This challenge is best

illustrated by another early women and AIDS project, the Women and AIDS Resource

Network (WARN). Founded the same year as WAP, WARN was begun by Marie St. Cyr

and served as a support group for HIV-positive women and women with AIDS in New

York City. WARN’s mission statement was based in a philosophy of empowerment and 156 “AIDS: Its Impact on Women, Children, and Families” Report of the Public Hearing, June 12, 1987 New York, p. xiv, Linda Loffredo Personal Papers. 157 Ibid, p. 7.

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was committed to providing “counseling, education, and organizing self-help efforts to

empower women to cope with and prevent the spread AIDS.”158 The organization also

committed to having majority women of color staff and board, while being heavily

supported by the well-connected infrastructure of WAP.159 For St. Cyr, WARN and the

women who were able to reach out to the organization played a significant part in shifting

the discussion around the epidemic in New York. “Having women represent themselves

was key, that women were finally able to stand up and say I am a woman and I am HIV-

positive and I am deserving of service…when women started speaking up across the city

in their own voice that’s when we began to really see changes.”160

Yet as vital as WARN was, it struggled to keep up with the need and find

adequate resources, particularly as the number of women with HIV grew at an even faster

rate during the latter half of the 1980s and into the 1990s. Because of its direct service

provision, WARN, even more so than WAN and WAP, quickly became overwhelmed

with requests for information, services, and casework. In 1990, WAN urged its members

to support WARN with donations. “WARN remains, to our knowledge, the only

women’s specific AIDS service agency in New York State, perhaps in the country. That

it must struggle continually for money is something that is not surprising to us, but is

surely infuriating.”161 The need for WARN to expand was strikingly apparent, and in

158 “Women and AIDS Project,” Spring 1990, p. 3, Linda Loffredo Papers. 159 WAP’s main strategy for getting prominent New York City women’s organizations and philanthropists to invest resources in the AIDS epidemic was by hosting invitation only “leadership breakfasts” in which women well known in the fields of AIDS research and advocacy would speak on different issues pertaining to women and the epidemic. This tactic was quite successful. In 1990, Vogue hosted the leadership breakfast with Diane Sawyer acting as master of ceremonies. This breakfast in particular would help to secure the necessary funding for Iris House’s opening. See Women and AIDS leadership Breakfast pamphlet, Gena Corea Papers, Sophia Smith Collection. See also interview with Marie St. Cyr, interview with Suki Ports, both on file with author. 160 Interview with Marie St. Cyr, January 30, 2013, on file with author. 161 “Women and AIDS Project,” Spring 1990, p. 3, Linda Loffredo Papers.

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short order WARN became Iris House, billed as the first comprehensive AIDS services

organization dedicated to providing family focused services to women of color affected

by HIV/AIDS.162 With continued support from WAP, WARN staff and some of its

clients planned the opening of Iris House—complete with residencies—in East

Harlem.163

In the first year of operation, the organization was equipped to serve fifty women

but ended up stretching resources to serve the more than three hundred women from New

York City and Long Island that showed up at its door. Iris House attempted to implement

the kind of comprehensive service that women and AIDS advocates had been describing

since the early years of the epidemic, services that would “sustain a safe, supportive, life-

enhancing environment for women who are living with HIV/AIDS and their families.”164

In addition to the case management and support groups that WARN had worked to make

available on a small scale, Iris House had units of housing where women could live with

their families, child care for when women were attending appointments, a kitchen for

162 This claim requires some explanation. Most significantly, especially considering its proximity, the New Jersey Women and AIDS Network in New Jersey had been working to address the high numbers AIDS cases in women in the state since 1988. SisterLove, a reproductive health organization for women of color focused on the epidemic, started operating in Atlanta, GA in 1989. These groups were more like WARN than WAP and WAN in that they did provide HIV testing and counseling services as opposed to just doing education and advocacy. They also made women’s empowerment a fundamental component of their work with women. However, neither organization offered—and does not currently offer—the range of services Iris House did—and does—when it opened its doors in 1992. Comprehensive services meant something very specific to the women involved in WARN who together envisioned the organization that would become Iris House. 163 “Neighborhood Report: Harlem; A Center to Help Women with AIDS,” New York Times, 19 Sep 1993, A6. Interview with Marie St. Cyr, January 30, 2013, on file with author. 164 Iris House “Wheel of Services” handout, HIV Law Project Records.

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workshops on nutrition, meal provision, psychological services, and legal services and

did community outreach and education in East Harlem.165

Yet Iris House offered more than just the comprehensive services that women and

AIDS projects had long been advocating for. According to Cyr, the philosophy of

establishing trust in order to facilitate empowerment permeated every aspect of Iris

House’s operations. As a result, the spaces made available for these women were

overwhelmingly defined by an acknowledgement of the social complexities wrought by

AIDS. This philosophy was applied at the smallest level of detail, such as using

envelopes without return addresses in the event women had not shared their status with

their families. In this way, Iris House balanced the important visibility work early women

and AIDS organizations accomplished with the understanding that for the majority of

women facing a positive diagnosis, multiple aspects of their lives conspired to make

embracing visibility difficult, possibly even dangerous.166

In Moving Politics, sociologist Deborah Gould warns against treating caretaking

and service provision responses to AIDS as simply a precursor to direct action AIDS

activism, especially the work of AIDS Coalition to Unleash Power (ACT UP). Gould

admits that her own inclination to do the very thing she cautions her readers against

results from a single question: “why lesbians and gay men did not take the streets

165 Interview with Marie St. Cyr, January 30, 2013, on file with author. While Iris House has significantly broadened the populations it serves since Marie St. Cyr stepped down as executive director, its current list of services are available here: http://irishouse.org/programs-and-services/program-overview.html 166 For example, women and AIDS advocates across the board criticized safe sex educational materials that assumed women had the same negotiating power as men when it came to condom use. They also highlighted the need for discretion when it came to a woman’s HIV status in particular because of potential retaliation from an abusive partner.

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earlier.”167 While my interest in early women and AIDS projects has been about how

advocates understood the effects of the epidemic for women, Gould’s concern illustrates

the power of framing to obfuscate or reveal. There are many possible reasons why the

early work of women and AIDS projects have not received more attention, but Gould

gestures to ACT UP’s legacy as a potential reason. Both theatrical and confrontational,

the tactics of ACT UP largely define activist narratives concerned with the first fifteen

years of the epidemic, making it seem as everything else is, as Gould writes, “not ACT

UP.”168 In discussing an altogether different legacy, the legacy of a woman-centered

service response to the epidemic, Marie St. Cyr explained, “the leadership of HIV among

women of color had to rise from the ranks in a way that’s almost quiet, that’s almost quiet

because were it too loud it would be crunched on the onset.”169 This “quiet” leadership is

in stark contrast to direct action AIDS activism, and St. Cyr aimed to illustrate how

political protest not only comes in different forms, but also how some tactics are not

always available to those who are more vulnerable. Early women and AIDS projects

performed the complicated work of highlighting women’s risk while proclaiming their

needs, emphasizing women’s vulnerability in the service of making sure they were strong

enough to overcome the disease. In the process, they refused to see the epidemic in a

vacuum untouched by poverty, race, gender, or reproduction. This alternative

understanding of the epidemic was often met with resistance and was rarely

institutionalized. Despite the fact that this has made early efforts all the more difficult to

167 Deborah Gould, Moving Politics: Emotion and ACT UP’s Fight Against AIDS, University of Chicago Press, 2009, p. 56. 168 Ibid. 169 Interview with Marie St. Cyr, January 30, 2013, on file with author.

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see, women and AIDS projects played a vital role in gendering both the epidemic and

municipal level responses.

Moving Beyond Reproduction Only to Return

Women and AIDS advocacy that aimed to alter federal policy was far more

visible than early women and AIDS projects; indeed, advocacy that occurred during the

late 1980s and early 1990s benefitted from the ground work laid by projects that had

established women’s stake in the epidemic. It was also getting harder to deny the reach of

the epidemic. By 1990, AIDS had become the fourth leading cause of death for women

ages 24-40.170 In New York and New Jersey, AIDS had been the leading cause of death

for Black women ages 15-44 since 1988.171 However, the women and AIDS advocates

who focused on women’s reproduction in the context of experimental drug trials would

still struggle for recognition, both during the epidemic and in retrospective accounts of

their advocacy. Broader, more visible Congressional-level women’s health advocacy and

direct-action AIDS activism often obscured women and AIDS advocates working at these

intersections. AIDS was not widely considered a women’s health issue until the mid to

late 90s and women-specific projects were not always a priority within AIDS activist

networks. Given this, understanding the significance of the clinical trials debate as

articulated by women and AIDS advocates first requires outlining the debate’s its

170 “Current Trends AIDS in Women—United States. MMWR Weekly, 39(47), November 30, 1990; Susan Y. Chu, James W. Buehler, Ruth L. Berkelman, “Impact of the Human Immunodeficiency Virus Epidemic on Mortality in Women of Reproductive Age in the U.S.,” Journal of the American Medical Association, 264 (2), July 11, 1990. 171 “Current Trends Mortality Attributable to HIV Infection/AIDS—United States, 1981-1990,” MMWR January 25, 1991, 40(3); 41-44.

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significance for another group whose influence grew during this period: the women’s

health lobby.

The first fifteen years of the AIDS epidemic unfolded alongside efforts to make

women’s health a priority in biomedical research. During this period, a powerful

women’s health lobby and the Congressional Caucus for Women’s Issues pushed

women’s health to the fore of domestic politics.172 These advocates argued that women’s

health was underfunded, under researched, and overly concerned with reproduction. As a

result of this neglect, much of what women were told about disease and treatment was

based on research performed on male subjects. According to advocates, researchers

needed to study the gender-based differences of diseases and drug treatments in order to

truly understand women’s health. As they set out to make significant reforms to the

biomedical establishment, advocates realized that focusing on women’s exclusion from

clinical trials could garner support for their broad cause.

In 1985, the Public Health Service (PHS) Taskforce on Women’s Health issued a

report titled “Women’s Health.” Assembled two years prior, the taskforce was charged by

then Assistant Secretary of Health Edward Brandt with “identifying the aspects of

women’s health that are most striking in today’s environment.”173 A subcommittee had

gathered significant input from “non-federal health organizations in assessing the special

health needs of women.” Reflecting the philosophy of groups that grew out of the

women’s health movement of the late 1960s and 1970s, the subcommittee emphasized

the societal determinants of women’s health and challenged the idea that it was simply a

172 For detailed overviews of this political process see Carol Sachs Weisman, Women’s Health Care: Activist Traditions and Institutional Change, Baltimore: Johns Hopkins University Press, 1998, 77-93 and Epstein, Inclusion, 74-83. 173 U.S. Public Health Service (1985, 74).

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medical issue. Poverty and unemployment in particular affected women’s ability to

access the healthcare system, and certain “subgroups” of women such as “ethnic

minorities, homosexual women, and incarcerated women” required care that was

sensitive to their specific circumstances and needs. 174

These “socialization practices” received mention in the executive summary, but

the report’s section on “Conducting Research and Evaluation,” which outlined the

necessity of biomedical research dedicated to disease manifestation in women, would

prove most popular with the burgeoning women’s health lobby. Perhaps even more

striking, however, was Brandt’s introductory comments. Brandt promised the public that

the report would not “focus strictly on the diseases and problems unique to women in the

traditional sense—that is reproductive problems—but rather is devoted to assessing the

problems of women’s health in the context of the lives women in America lead today.”175

Reflecting feminist critiques of medical models that equated women’s health to their

reproductive organs and used a male model as the “gold standard” for medical research,

the position taken in the report was firmly committed to broadening the bounds of

women’s health.

Yet Brandt’s desire to move women’s health beyond those “problems unique to

women in the traditional sense” proved easier said than done, particularly with regards to

the goal of increased biomedical research on disease in women. In response to the

recommendations put forth in the 1985 report, the National Institutes of Health (NIH)

instituted a policy to ensure the inclusion of women and minorities in research study

174 Ibid 98, 100. 175 Ibid 74.

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populations.176 Yet five years later a General Accounting Office (GAO) Report initiated

by Congressional representatives Olympia Snowe and Patricia Schroeder found that the

NIH had “made little progress in implementing its policy.”177 The report noted that

“although the policy first was announced in October 1986, guidance for implementation

was not published until July 1989, and the policy was not applied consistently before the

1990 grant review cycles.”178 Attempting to curb the political fallout caused by

widespread media coverage of the negative findings, NIH Director William Raub

announced the creation of an Office of Research on Women’s Health. The agency’s first

report tasked the NIH and the FDA with ensuring women’s adequate representation in

clinical research.179

Resistance to including women in biomedical research was largely driven by past

tragedies resulting from little to no regulation of experimental drug testing. The

distribution of thalidomide for morning sickness in the 1950s had caused major birth

defects in children born to women who had taken the drug. While the majority of

distribution occurred in Germany, the episode prompted passage of the Kefauver Harris

Amendment to the Food, Drug, and Cosmetic Act in 1962. For the first time in the FDA’s

history, drugs would have to be proven safe and effective before receiving approval. As a

result, subjects of experimental testing were suddenly vulnerable to harm, and

176 National Institutes of Health (1986). 177 The Alcohol, Drug Abuse and Mental Health Administration (ADAMHA) also sponsored the policy, but this had little impact. Furthermore, any sort of guideline for implementing the new policy was not published until three years after the NIH’s announcement that researchers needed to include women in clinical trials. See General Accounting Office (GAO), 1990. For a more detailed account of how Representatives Snowe and Schroeder decided to go after the NIH’s policies in order to leverage their broader goals for women’s health such as passage of the Women’s Health Equity Act, see Epstein, Inclusion, 76-78. 178 GAO (1990, Summary). 179 Office on Women’s Health (1991).

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pharmaceutical companies faced the relatively new possibility of litigation.180 Shortly

after thalidomide, the negative effects of diethylstilbestrol (DES) and the intrauterine

device Dalkon Shield made women’s protection from research an important issue for the

grassroots women’s health movement, while popular press coverage of the long-running

Tuskegee study also contributed to calls for increased protection of research subjects. The

1974 National Research Act created even more regulatory mechanisms aimed at

protecting subjects from undue risks, including the National Commission for the

Protection of Human Subjects of Biomedical and Behavioral Research. This commission

singled out the fetus and pregnant woman as especially vulnerable subjects that should

not be subjected to experimental research.181 In 1977, the FDA followed suit and advised

researchers against the inclusion of “women of childbearing age” in clinical trials until

animal reproduction studies had determined the effective drug was not also a teratogen—

a drug capable of producing fetal malformation.182

Harm as a result of insufficient protections and increased oversight of drug

development had made premenopausal women a decidedly undesirable research

population by the time women’s health became a popular issue amongst sections of

Congress and their lobbying counterparts. As Steven Epstein has shown, beginning in the

180 Pharmaceutical companies’ more conservative approach to participants was targeted primarily at women Johnson, Tracey and Elizabeth Fee. 1994. “Women’s Participation in Clinical Research: From Protectionism to Access.” In Women and Health Research: Ethical and Legal Issues of Including Women in Clinical Trials Vol. 2, eds. Mastroianni, Anna C., Ruth Faden, and Daniel Federman, 1-10. Washington D.C.: National Academy Press. For a discussion on how the concept of the research subject in the U.S. is a historically contingent one, see Epstein, Inclusion, 30-52. 181 Department of Health, Education, and Welfare (1975). 182 “Women of childbearing age” was defined as: “a premenopausal female capable of becoming pregnant. This includes women on oral, injectable, or mechanical contraception; women who are single; women whose husbands have been vasectomized or whose husbands have received or are utilizing mechanical contraceptive devices.” The animal reproduction studies did not happen until a drug had been found safe and somewhat effective in Phases 1 and 2, leaving women ineligible until these studies were completed and Phase 3 trials were underway. Department of Food and Drug Administration (1977).

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1980s different underrepresented groups laid claims to “inclusion” in order to reform the

way difference—including race, gender, sex, and age—was acknowledged, researched,

and ultimately incorporated into biomedicine.183 The first GAO report revealing the

NIH’s failure to enforce its inclusion policies falls squarely within this tradition, with the

swift reaction it garnered from the NIH evidence of the framework’s power and efficacy

during this period. Building on the public support generated by the NIH report,

Representatives Snowe and Schroeder applied their GAO investigation tactic to the

FDA’s inclusion policies. The second GAO report found that women were generally

underrepresented in trials and that even studies with sufficient numbers of women had

not been analyzed for gender-based differences.184 As a result, the FDA guideline that

barred women of childbearing age from clinical trials became the target of an

increasingly powerful constituency dedicated to making women’s health an institutional

priority.

Despite the fact that groups like WAN, WAP, and WARN were forming at the

same time governmental health officials were reexamining women’s health, it would take

more time for the distinct political issues of AIDS in women and women’s health to

intersect. A different strain of women and AIDS advocacy would facilitate this

intersection, though not intentionally. By the late 1980s, Women’s Caucuses in ACT UP

chapters had turned their efforts towards federal health agencies, expressing many of the

same concerns raised at the start of the epidemic by advocates who claimed women were

183 Steven Epstein, Inclusion: The Politics of Difference in Medical Research, Chicago: Chicago University Press, 2007. 184 GAO (1992).

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at risk.185 One of their biggest—and ultimately successful—campaigns was directed at

convincing the CDC to expand the official definition of AIDS to include opportunistic

infections more often found in women and poor people.186 The aggressive targeting of

federal health institutions was representative of the turn within the direct-action AIDS

movement to pressure those with control over the development and distribution of HIV-

and AIDS-related drugs. AIDS activists had long criticized regulatory drug policies that

made approval of new drugs a nearly decade long process. But by the late 1980s, the

movement had begun successfully intervening in drug testing procedures, offering their

own thoroughly researched suggestions of how the FDA and National Institute of Allergy

and Infectious Diseases (NIAID) could expand access to experimental HIV and AIDS

drugs, speed up approval, and make clinical testing more humane.187

Whose “Reproductive Risk”?

185 For example, after immense pressure from AIDS activists, particularly women involved with ACT UP chapters in New York, D.C., and San Francisco, NIAID and NIH sponsored the first national conference on women and AIDS in D.C—“Women and HIV Infection.” Recently appointed Surgeon General Antonia Novello told conference attendees “if there was a day when we thought AIDS was not a problem for women, it has long passed…there is no more age of innocence with women and AIDS.” Transcript of address to conference, Folder “DC Conference—1990, December,” Box 3 of 8, Acc #95S-51, Gena Corea Papers, Sophia Smith Archives. In addition to demanding the conference, activists also attempted to work with NIAID director Anthony Fauci on the program. When activists felt NIAID had ignored their suggestion that speakers be either HIV positive women or those working closely with this population, they resigned from the steering committee and withdrew their support for the conference. See Gena Corea, The Invisible Epidemic: The Story of Women and AIDS. New York: Perennial, 1993, 224-227, 269-270. For a discussion of how activist women’s concerns regarding the sexism of federal AIDS officials are legitimate see Gould, Moving Politics, 361-362. 186 Advocates, including HLP, argued that the narrow CDC definition kept women and poor people from receiving social security benefits because their symptoms did not result in an “official” diagnosis, thereby disqualifying them from support. See McGovern (1994) and Gould (2009, 350-351). 187 For example, by 1989 Anthony Fauci had expressed public support for activists’ “parallel track” model for expanding access to AIDS drugs. For a thorough discussion of this and the other changes that resulted from AIDS activism see Mary M. Dunbar, “Shaking up the Status Quo: How AIDS Activists Have Challenged Drug Development and Approval Procedures,” Food, Drug, Cosmetic Law Journal 46, 1991, 673-706 and Epstein, Impure Science, 208-294. For a discussion of how activists’ greater involvement with AIDS officials caused the tensions within the direct action AIDS movement, particularly ACT UP chapters, see Gould Moving Politics, 267-438 and Epstein, Impure Science, 265-329.

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Most of the efforts directed at the levers of power within federal health agencies

were motivated by a belief that getting “drugs into bodies” was the best hope for people

with a positive diagnosis. In the face of an epidemic with no cure, activists believed such

treatments should be widely available. By 1990, AZT was the only approved AIDS drug

and it was highly toxic. In an environment where so little was known about the disease,

and where a positive diagnosis meant almost certain death, experimental drugs that had

yet to be proven effective were far more promising than no treatment at all. Participation

in clinical trials was the only way that those with AIDS could legally access experimental

treatments during the years the epidemic continued to confound drug developers. The

accessibility of this treatment strategy, however, varied widely depending on race, class,

gender, and insurance status. The majority of trial participants were white men with

access to private healthcare. 188 Women in the New York City chapter of ACT UP

provided detailed records of exclusionary policies utilized by federally funded AIDS

Clinical Trial Groups (ACTG) sites.189 In addition to highlighting these official exclusion

policies, activists also pushed trial sites to provide additional supports like childcare and

reimbursement for transportation costs. Citing social factors such as women’s likely

caretaking responsibilities, as well as biological factors such as the perception that

women’s reproduction made them “undesirable” test subjects, advocates protested

188 Steven Epstein, Inclusion, 63. 189 See for example Maxine Wolfe and Iris Long, “Through the Eye of a Needle: Women’s Access to Drug Treatments Through Clinical Trials,” Women & AIDS, Section 3.C, Reel 54, Box 73, Folder 12, ACT UP New York Collection, New York Public Library; Iris Long, “Women’s AIDS Treatment Issues: 1991 Update,” Reel 137, Box 166, Folder 9, ACT UP New York Collection, New York Public Library.

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women’s exclusion from one of the only viable treatment strategies with the slogan

“Women cannot wait ‘til later, we are not your incubators!”190

Women in ACT UP had a broad critique of women’s exclusion from clinical

trials, but a woman named Mary Lucey would help direct women and AIDS advocates’

treatment activism at the FDA guideline excluding women of child-bearing age from

clinical trials. Around the same time Congress announced the results of the GAO report

detailing the FDA’s exclusionary practices, the HIV Law Project (HLP), a legal advocacy

organization providing legal aid to low-income HIV-positive people in Manhattan, took

on Mary Lucey’s case. Lucey had experienced extreme side effects when prescribed

AZT. Her doctor instructed her to enter a clinical trial testing tat-inhibitors, drugs

designed to inhibit certain proteins and freeze replication of the virus. Those running the

trial, however, informed her that she could begin participation only after undergoing

sterilization. Upon refusal, Lucey was barred from entry.191

HLP helped Lucey gain access to Phase 2 of the trial and used the suit as a

platform to take on the 1977 FDA guideline. Along with a number of other civil liberties,

women’s, and AIDS organizations, HLP filed a Citizen’s Petition on December 15th,

1992 that characterized the guidelines as gender discrimination. 192 The petition

190 “How ACTG Trials are Designed to Exclude Women,” Treatment and Research Agenda for Women with HIV, 1991, ACT UP, Box 1 of 8, Acc. # 95S-51, Gena Corea Papers, Sophia Smith Collection. Demonstrators chanted this, for example, during the 1990 International AIDS conference held in San Francisco. See Epstein, Inclusion, 85. 191 This left Lucey with no other treatment options, as the negative side effects she experienced from AZT were the original reason her doctor suggested enrolling in the trial. See Theresa M. McGovern, Martha S. Jones, and Martha Davis, October 18, 1993, “Memorandum on the FDA’s Proposed Guideline for the Study and Evaluation of Gender Differences in the Clinical Evaluation of Drugs,” p. 1-2, Folder National Organization for Women, Box N, Barnard Center for Research on Women Archives (hereafter HLP Memorandum). 192 These organizations included: NOW Legal Defense and Education Fund, AIDS Project of the ACLU, AIDS Service Center Lower Manhattan, ACT UP Women’s FDA Working Group, AIDS Counseling and Education for Women in Transition from Correctional Facilities, New Jersey Women and AIDS Network,

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emphasized how HIV and AIDS were “a matter of life and death for women whose only

hope of treatment was enrollment in a clinical trial.”193 In doing so, the coalition claimed

women’s right to the treatment strategy popularized by middle-class gay men and framed

as a right by the direct-action AIDS movement. Women’s access to experimental drugs

was a matter of survival.

With the respective publications of the petition and the GAO report, the efforts of

advocates for women’s health and women and AIDS activists intersected at the FDA

guideline despite their vastly different origins and aims. Women’s participation in clinical

trials became a major topic of debate, one that pivoted around the question of fetal

protection. Feminist lawyers writing at the time went to great pains to allay researchers’

and pharmaceutical companies’ fears of legal liability, arguing that informed consent

would protect against the chances of being sued by either a female participant or her

offspring.194 Those representing pharmaceutical companies rejected this legal reasoning,

with the executive director of Bristol Myers Squibb arguing that “a change in federal law

would be required to decrease any sponsor liability” due to the fact that most states

allowed suits on behalf of the fetus.195 Some physicians in favor of increasing women’s

access to experimental drugs argued that the “assumption in the research community and

its funding sources that the normal forms of protection afforded the human subject are

Housing Works, and Mary Lucey who brought the original case to HIV Law Project. “Citizen Petition,” December 15, 1992, AIDS Service Center, HIV Law Project, NOW Legal Defense and Education Fund, ACLU AIDS Project, HIV Law Project Papers (Hereafter HLP Citizen Petition). 193 HLP Citizen Petition (1992, 9). 194 See Sandomire, Hazel. 1993. “Women in clinical trials: are sponsors liable for fetal injury?” The Journal of Law, Medicine, and Ethics 21(2): 217-230; Bowles, L. Elizabeth. 1992. “The Disfranchisement of Fertile Women in Clinical Trials: The Legal Ramifications of and Solutions for Rectifying the Knowledge Gap.” Vanderbilt Law Review 45(877): 877-920. 195 See Bush, Janice K. 1994. “The Industry Perspective on the Inclusion of Women in Clinical Trials.” Academic Medicine 69(9): 708-715, p. 713.

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insufficient when that subject is a woman of reproductive potential” lacked “sound

logical foundation and has had grave consequences for the advancement of knowledge of

disease in the female.”196 While those representing the FDA attempted to take a more

neutral position by steering clear of arguments related to cost and liability, they

nonetheless framed the reasons for women’s exclusion as self-evident. Ruth Merkatz,

who would become the main spokesperson for the FDA on this issue, referenced past

tragedies to show how “the checkered history of clinical research in this country” would

make one “wonder why women might wish to be included in clinical trials.”197

In July of 1993, the FDA announced that it would lift the ban on women’s

participation, stating “The 1977 guideline, seen from the viewpoint of the 1990s, has

appeared rigid and paternalistic.”198 The passage of the NIH Revitalization Act and the

creation of the Office of Women’s Health within the office of the FDA commissioner

followed on the heels of the FDA’s initial announcement, making 1993 a winning year

for women’s health advocates. In her new position as director of the Office of Women’s

Health, Merkatz announced the changes in the New England Journal of Medicine. She

attempted to assuage both sides of the debate by acknowledging that while the previous

guidelines reflected outdated “paternalism…nothing has changed at the FDA with respect

to the important and justifiable concern for fetal protection.”199 With this article, Merkatz

inaugurated a publication trail that ensured FDA control over the narrative of the

evolution of women’s participation in clinical trials. Publishing in the major science and

196 Howard Minkoff et al., “Fetal Protection and Women’s Access to Clinical Trials,” Journal of Women’s Health, Vol .1, No. 2, 1992, 138. 197 See Merkatz, Ruth B. and Suzanne White Junod. 1994.“Historical Background of Changes in FDA Policy on the Study and Evaluation of Drugs in Women.” Academic Medicine 69(9): 703-706, p. 703. 198 Department of Health and Human Services (1993, 39406). 199 Merkatz, Ruth B. et al. 1993. “Women in Clinical Trials of New Drugs—A Change in Food and Drug Administration Policy.” New England Journal of Medicine 329:292-296.

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health journals and magazines, Merkatz told a story about an internal shift in thinking

that prompted the FDA’s decision to overturn overly protectionist attitudes towards

women.200 While there was sometimes a nod to pressure from the women’s health lobby,

the role of women and AIDS activists was not only omitted but entirely reimagined as

having never been affected by the guideline. Without fail, Merkatz’s announcements

mentioned the exception built into the 1977 guideline that allowed women into any phase

of testing if they had a life threatening illness, stating “women with conditions such as

cancer, and, more recently, AIDS have been included in the earliest phases of drug

trials…the potential risk to the fetus was balanced by the compelling possibility of

prolonging the life of the mother.201” As a result, the FDA made it seem that the policy

had never impacted women with these illnesses. With this omission present in both the

official FDA narrative and subsequent accounts of this development, the clinical trials

debate has remained a story of women’s victory over biomedicine. Reproduction would

no longer limit women’s access to biomedical research and treatment.

In contrast to Merkatz’s account, scholars studying the epidemic or changes to

women’s health have discussed how the FDA’s policy affected the issue of women and

200 In addition to articles cited in the text see Merkatz, “FDA: Making a Difference in Women’s Health,” Journal of the American Medical Women’s Association 49(4): 117-121; (1994), Sherman, Temple, and Merkatz, “Women in Clinical Trials: An FDA Perspective,” Science 269 (August): 793-795, 1995; Merkatz, Ruth B. and Elyse I. Summers, “Including Women in Clinical Trials: Policy Changes at the Food and Drug Administration,” in Women’s Health Research: A Medical and Policy Primer, eds. Haseltine, Florence P. and Beverly Greenberg Jacobson, 265-284, 1997, Washington, D.C.: Health Press International. Once HIV/AIDS had been officially recognized as a pressing women’s health issue in 1995, Merkatz published an article about the FDA’s commitment to women with AIDS. Even here, however, she maintained that women with life-threatening illnesses had never been denied access to clinical trials under the old FDA guideline, Merkatz (1995). 201 Merkatz, Ruth B. et al. 1993. “Women in Clinical Trials of New Drugs—A Change in Food and Drug Administration Policy.” New England Journal of Medicine 329:292-296, p. 295.

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AIDS. A few even attribute the reversal, at least in part, to women and AIDS activism.202

For the most part, however, scholars acknowledge the negative impact women’s

exclusion had both on women with AIDS and AIDS research during this period.203 These

accounts have helped legitimate the claims of those who spoke out on behalf of women

with AIDS from the very start of the epidemic and, much like the citizen petition, remind

us that for some women exclusion cost them their lives.

These accounts do not, however, move us closer to fully understanding HLP’s

demands or the multiple stakes of the clinical trials debate. The citizen petition targeted

the 1977 FDA guideline in part because the company that had denied Lucey referenced it

in defense of its exclusion criteria.204 The guideline barred women from accessing Phase

1 and 2 trials where drugs were tested for safety and efficacy, respectively. If HIV-

positive women were going to garner any potential benefits from experimental drugs,

advocates argued, they needed to be able to access those drugs as soon as possible—they

simply did not have time to wait to see if the drugs proved safe and effective in male trial

participants who were supposedly without reproductive risk. Those working on a broad

women’s health plan, however, were not as concerned with getting women into early

phases of trials as they were with including women in large enough numbers that results

could be analyzed for gender-based differences. AIDS activists wanted equal access to

the full range of experimental stages of drugs. Advocates for women’s health wanted to

202 See McGovern, Theresa M., Martha Davis, and Mary Beth Caschetta. 1993. “FDA Policy on Women in Drug Trials.” New England Journal of Medicine 329(4): 1815; Corrigan, Oonagh P. 2002. “‘First in Man’: The Politics and Ethics of Women in Clinical Drug Trials.” Feminist Review 72: 40-52; Epstein, Inclusion, 55. 203 See Laurence, Leslie, and Beth Weinhouse, Outrageous Practices: The Alarming Truth about How Medicine Mistreats Women, New York: Fawcett Columbine, 1994, 149-152; Treichler, How to Have a Theory in an Epidemic, 247-251; Epstein, Impure Science, 260-261; Corea, Invisible Epidemic. 204 HLP Memorandum (1993, 2).

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ensure that drugs being funded by the NIH and being approved by the FDA would be safe

and effective in women as well as men. This distinction is made most evident by the fact

that the 1992 GAO Report evaluating the FDA’s practices explicitly tabled whether or

not the 1977 guideline was applied to Phase 1 and 2 trials—advocates for women’s health

were largely concerned with including women in representative numbers before trials

were completed.205 In the case of the clinical trials debate, the two political factions

fighting for women’s access to biomedical research had very different reasons for doing

so.

As a result, their demands regarding the conditions of access also differed. Far

from simply wanting the guideline lifted, the petitioners rejected the notion that women’s

reproductive capacity was something that necessitated a balancing act, with women’s

health on the one hand and the health of the potential fetus on the other. Rather than

arguing that women be free to take on reproductive risk, the petitioners accused the FDA

of endangering the reproductive health of both male and female participants by failing to

complete animal reproductive studies prior to the start of Phase 1 testing. By demanding

that all animal studies be completed before the testing of human subjects, the petition

sought to “remedy FDA 77-3040’s constitutional infirmity by distinguishing between

potential trial participants based not on childbearing potential or pregnancy, but on the

reproductive effects of the experimental drugs.”206 In an attempt to render women’s

205 GAO 1(992, 2). This distinction is also evidenced in women’s health advocates subsequent engagement with FDA officials. Following the reversal, these advocates continued pressing the FDA to apply stricter requirements for analyzing study results for gender-based differences. Accounting for the gendered effects of treatment rather than gaining women access to the early phases of trials remained the goal of the women’s health lobby into the early 2000s. See Epstein, Inclusion, 167-168. 206 It is important to note that the petition made the argument for women’s freedom of choice while also demanding that experimental drug research be overhauled. The recently decided case of UAW v. Johnson Controls that forbid sex-specific fetal protection policies in the workplace took center stage in the petition because its authors felt that it was “analytically similar” to the case of clinical trials. In making this

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reproduction irrelevant, the petition proposed that experimenters first determine that

drugs were safe for reproductive systems instead of simply excluding participants more

likely to suffer fetal abnormalities. Petitioners saw no reason why a woman’s

participation needed to be contingent on potential fetal harm. They rejected the logic that

the capacity for pregnancy implied an inherent conflict between a woman’s health and

the health of the fetus. Rather, the way clinical trials were conducted created this conflict.

By changing the structures of experimental research, women’s capacity for pregnancy

would no longer be regarded as an additional risk.

In light of this demand, it should come as no surprise that HLP continued to press

the FDA after the 1993 announcement.207 Arguably, women’s health advocates should

not have been satisfied either. The FDA announcements from Merkatz made it clear that

the reversal lacked regulatory force and stated that the FDA did not “specify what the

community must do,” but instead entrusted such decisions “to internal review boards,

patients, and their physicians.”208 At a meeting with FDA representatives and AIDS

organizations held shortly after the guideline had been announced, the Director of the

argument the centerpiece, petitioners offered up the logic that women had the right to choose to endanger their reproductive capacity by participating even if animal studies had shown danger of reproductive risk at the same time that they offered concrete ways to better protect against the reproductive harm of all trial participants. In short, the petition coalition was not afraid to make demands that structurally accounted for women’s capacity for pregnancy, but their main legal precedent was one that emphasized women’s sameness with men. HLP Citizen Petition (1992, 23, 75). 207 Arguably, women’s health advocates should not have been satisfied either. Even the initial FDA announcements were clear that the reversal lacked regulatory force and stated that the FDA did not “specify what the community must do,” but instead entrusted such decisions “to internal review boards, patients, and their physicians,” Sherman, Temple, and Merkatz, “Women in Clinical Trials: An FDA Perspective,” 794. At a meeting with FDA representatives and AIDS organizations held shortly after the guideline had been announced, the Director of the Division of Antivirals in the Center for Drug Evaluation and Research—an agency housed by the FDA—reiterated this point, telling attendees that the FDA had no authority to tell drug companies which populations to study. See Iris Long, 1993, “What happened at the Aug 9the 1993 meeting with the FDA? Summary,” Reel 137, Box 166, Folder 9, ACT UP New York Papers, New York Public Library. 208 Sherman, Linda Ann, Robert Temple, and Ruth Merkatz, “Women in Clinical Trials: An FDA Perspective,” 794.

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Division of Antivirals in the Center for Drug Evaluation and Research—an agency

housed by the FDA—reiterated this point, telling attendees that the FDA had no authority

to tell drug companies which populations to study.209 In a widely circulated

memorandum, petitioners criticized the new guideline for failing to “address the FDA’s

overall failure to monitor the conduct or results of animal reproduction studies or to halt

trials which unnecessarily restrict women of childbearing potential…because in the past,

the FDA had a policy mandating gender discrimination, the FDA must now act

affirmatively and aggressively to eradicate such discrimination. The FDA must do more

than recommend the inclusion of women and a by-gender analysis of drug response, the

FDA must mandate this approach.”210

Two years after the initial petition had been submitted, the petitioners received a

response from the FDA. While the FDA expressed great concern about low numbers of

women in AIDS related trials, it also used Merkatz’s line, telling petitioners “this

underrepresentation cannot be attributed to FDA restrictions because FDA has never

recommended gender-based restrictions in clinical trials of drugs intended to treat life-

threatening illnesses.”211 Ultimately, the response stated “a routine requirement for

completion of all reproductive studies before Phase 1 likely would hinder rather than

promote drug development.”212

During this time, members of ACT UP New York continued monitoring the

numbers of women enrolled in federally funded trials nationwide as well as trials

209 See Iris Long, 1993, “What happened at the Aug 9the 1993 meeting with the FDA? Summary,” Reel 137, Box 166, Folder 9, ACT UP New York Papers, New York Public Library. 210 HLP Memorandum (1993, 4). This fear was valid, especially when it came to individual IRBs approving or not approving women’s entry. See Epstein, Inclusion, 65. 211 DHHS, October 27, 1994, 6, HIV Law Project Papers. 212 Letter to HLP from the Department of Health and Human Services, October 27, 1994, p. 12, HIV Law Project Papers.

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sponsored by drug companies being conducted in New York and New Jersey. A report

issued in September of 1994 reported that women’s enrollment in the ACTG program

had improved, with women making up 11.1 percent of all adult participants.213

Celebration over this improvement was tempered by a number of caveats. The ACTG

offered no information on the racial breakdown of the 11.1 percent women enrolled, a

cause for extreme concern considering women of color made up 83.1 percent of the total

AIDS cases in New York.214 Women were also greatly underrepresented in trials testing

treatment for adult opportunistic infections, accounting for only 8 percent of

participants.215 And lastly, women’s past underrepresentation was starting to have an

effect on women’s willingness to utilize the few approved anti-HIV drugs, none of which

had been tested for efficacy and safety in women during the trial period.216

As lawyers, physicians, researchers, advocates, and public health officials

continued debating the ethics of women entering clinical trials during this time, a number

of issues extending beyond the structure of experimental drug testing were raised that

echoed the concerns of early women and AIDs projects—specifically how social barriers

might keep women in trials low despite recent federal support for inclusion. Those

concerned about what women’s inclusion in experimental research meant for women of

color argued that past abuses had caused a deep mistrust of medicine amongst minority

populations and worried about how recruitment of specific research populations could be

213 “Women’s Access to Government Sponsored AIDS/HIV Clinical Trials: Status Report, Critique and Recommendations,” Iris Long and Juan “Alex” Leger, September 14, 1994, Reel 137, Box 166, Folder 9, ACT UP NY Papers, New York Public Library. 214 Ibid, 6. 215 Ibid, 14. 216 Ibid, 1-2.

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done ethically.217 Indeed, the authors of the petition had warned that requiring

sterilization of female participants was especially harmful for low-income women of

color given the history of forced sterilizations in the United States and the abuse of Black

research participants.218 Some suggested that to genuinely overcome the challenges that

accompanied recruiting poor people, women of color, and minorities into clinical trials,

research costs would have to be expanded to include funding for meals, social services,

transportation, childcare, and educational materials.219 Physicians who had extensive

experience working with both white women and women of color in healthcare and

research settings supported these recommendations, but changes revolving around

women’s responsibility as caregivers—childcare, flexible scheduling, and

transportation—were most loudly championed.220 Those invested in women’s access to

clinical trials considered women’s social as well biological reproductive differences.

217 Machelle Allen, “The Dilemma for Women of Color in Clinical Trials,” Journal of the American Medical Women’s Association, Vol. 49, Issue 4, 1994; Vanessa Northington Gamble and Bonnie Ellen Blustein, “Racial Differentials in Medical Care: Implications for Research on Women,” in Women and Health Research: Ethical and Legal Issues of Including Women in Clinical Studies, Vol. 2, National Academy Press, 1994. It is important to note that discussions about trials specific to HIV related diseases took place in the context of broader discussions about increasing the numbers of women and minorities in clinical research, where fierce debates waged about how increasing specific populations was harmful to the experimental method or not. However, AIDS was a powerful example even in these broader discussions because the incidence rate in black and Latino women specifically was rising faster than in any other group and yet women made up a very small percentage of the trial participants. Rarely did those on either side of the debate discuss gender and race in terms other than perceived biological difference, whereas those concerned with AIDS specifically very often articulated the social characteristics of gender and race, and demanded that trials be designed to accommodate the social aspects of participants’ lives. 218 Citizen Petition, 12. 219 El-Sadr W, Capps L, “The Challenge of Minority Recruitment in Clinical Trials fro AIDS.” Journal of American Medical Association, 1992, Vol 267, 954-957. 220 Diane B. Stoy, “Recruitment and Retention of Women in Clinical Studies: Theoretical Perspectives and Methodological Considerations” and Janet L. Mitchell, “Recruitment and Retention of Women of Color in Clinical Studies” both in Women and Health Research: Ethical and Legal Issues of Including Women in Clinical Studies, Vol. 2, National Academy Press, 1994. There is evidence that at least some FDA representatives were interested in how to make AIDS trial sites more accommodating to women, such as Bellvue Hospital in New York City had by offering childcare and whole family treatment when a woman came for her own primary care. This set up seems to have been one of the few, however. See the David Fiegel’s comments in “What happened at the Aug 9th 1993 Meeting with the FDA? Summary,” Iris Long, Aug 22, 1993, Reel 137, Box 166, Folder 9, ACT UP New York Papers, New York Public Library.

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In response to continued pressure, the FDA attempted to put more force behind

the guidelines. In 1995, the FDA proposed a rule that required researchers submitting

new drug applications to analyze subgroup differences. However, the rule would only

require sponsors to analyze existing data rather than requiring researchers to include

representative numbers of women. Founder of HLP Theresa M. McGovern described the

rule as “a retreat for the reluctant trial sponsor who is unwilling to analyze gender

differences” and argued that it would “not cure the egregious lack of knowledge about

how drugs affect women.” Her letter replied to the proposal by invoking more than a

decade of activism around women and AIDS. “Advocates for women have grown tired of

fighting with the FDA over these basic principles of drug testing. If the FDA continues to

answer the reasonable demands of the Task Force and countless advocacy groups with

meaningless regulations, we will reasonably question the ‘good faith’ of the FDA on the

subject of women. We will not tolerate more years of ‘lip service’ to women’s health.”221

Ultimately, the FDA proposed a “clinical hold” rule in 1997 that took an

additional three years to go into effect.222 Nearly twenty years after the beginning of the

AIDS epidemic in the United States, the FDA ruled that studies testing new drugs would

be put on clinical hold if they barred persons with a life threatening illness solely because

of potential reproductive risk.223 Given FDA representatives’ original argument that the

FDA was not responsible for the low numbers of women in AIDS related trials because it

“never recommended gender-based restrictions in clinical trials of drugs intended to treat

221 Ibid, 13. 222 Department of Health and Human Services (1997, 2000). 223 Ibid (2000, 34963).

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life-threatening illnesses,” this was especially significant.224 In addition to admitting that

women with AIDS had in fact been affected by the guideline, the FDA finally summoned

the regulatory power activists’ argued was necessary more than a decade prior. Having

stuck with the issue until its resolution in 2000, those working at HLP celebrated the

regulation.225 And while the clinical hold rule was, in the eyes of activists, originally

meant to be a mechanism by which more substantial changes could be enforced, from the

perspective of the FDA as well as pharmaceutical companies, it was a significant change

in terms of regulatory oversight.226 Indeed, the FDA reported that two comments it

received from sponsors regarding the proposed rule expressed continued concerns about

liability, while another comment suggested that this use of the clinical hold rule turned it

into a “punitive measure.”227 This, combined with the agency’s agreement with another

comment that expressed how little progress had been made both in terms of opening

enrollment to fertile women and overall numbers of women enrolled, are a testament to

the fact that despite being a far cry from the original demands of activists, the clinical

hold rule represented a significant challenge to the continued practice of excluding

women from trials.

224 Letter to HLP from Department of Health and Human Services, October 27, 1994, p. 6, HIV Law Project Papers. 225 In November of 2000, HLP held a community forum titled “HIV, Women, and Clinical Trials” publicizing passage of the clinical hold rule in order to “help HIV positive women and their advocates learn more about a new rule that can potentially increase the number of women who access clinical drug trials.” Letter to Roma Baran from Andrea B. Williams of the HIV Law Project, October 26, 2000, HIV Law Project Papers. 226 Theresa McGovern first introduced the clinical hold rule in the report she wrote while serving on the Presidential Advisory Council on HIV/AIDS. According to the federal register, the clinical hold rule was by and large a response to these recommendations. “Proposal to Eliminate Obstacles Facing Women in the Drug Development Process: A Recommendation to the National Task Force on AIDS Drug Development,” Theresa McGovern, June 30, 1994, 31, HIV Law Project papers; Federal Register, June 1, 2000, Vol. 65, No. 106, 34970. 227 Federal Register June 1, 2000, Vol. 65, No. 106, 34966-34967.

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In the proposed rule published in 1997, the FDA outlined the projected costs

associated with implementation of the clinical hold rule. “Implementation of this

proposed rule could impart additional direct costs to the industry in one area—the cost

associated with testing for pregnancy in women with reproductive potential who

volunteer to participate in clinical trials that would have previously excluded them.”228 At

most, providing pregnancy tests for the total number of women the FDA estimated had

been excluded from trials testing therapies for life-threatening illnesses would not exceed

$42,000. Of the forty-three protocols analyzed, only six entailed costs exceeding $1,000.

The FDA was firm in its assertion that the “societal benefits more than outweigh the

potential minimal additional costs.” 229

The impact analysis of pregnancy tests illustrates the dominant logic of the

clinical trials debate. Regardless of different groups’ position on the guideline, most

accepted the idea that reproducing bodies posed a problem for biomedical research. Yet

women and AIDS advocates’ demands reveal that it was, and is, possible to

conceptualize the relationship between women’s reproduction and biomedicine in an

entirely different way than those who saw them as necessarily and naturally in

opposition. Advocates wanted access to experimental drug treatments, but they also

wanted to eliminate entirely the reason for women’s exclusion. Rather than shifting the

burden of reproductive risk from the FDA to individual women as a solution to the

problem of reproduction, petitioners demanded that such risk be made irrelevant through

significant alterations to the experimental research model. In short, they refused to see

reproduction as a problem at all.

228 Federal Register, Sept 24 1997, Vol. 62, No. 185, 49953. 229 Ibid.

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Conclusion

In her study of the political frameworks that made possible the massive

institutionalization of women’s health in the early 1990s, Anne Eckman argues that

bipartisan support for such reforms was made possible by distancing women’s health

from “body parts and analyses of women’s health that are visibly associated with

‘difficult politics’” such as “contraception, sexual politics, and structural inequalities.”230

While Eckman’s reference to contraception and sexual politics largely invokes the

sidelining of abortion from Congressional legislation related to women’s health, her

argument about the “difficult politics” of women’s bodies can also be applied to the

women and AIDS advocacy that spanned the first fifteen years of the epidemic.

Advocates confronting the epidemic insisted that women required a different response,

one that accounted for their social and biological reproductive roles. While they may not

have always succeeded in making their various visions a reality for the women they

aimed to help, their efforts represent an alternative way of thinking about the epidemic,

both in terms of social service provision and treatment protocols.

The women and AIDS advocacy explored in this chapter offers an examination of

advocates that went against dominant ways of conceptualizing AIDS and women’s

reproduction. Rather than seeing women’s reproduction as a site in need of control,

advocates articulated women’s reproductive needs in order to demand support. The

clinical trial debate especially illustrates how the logic of control overwhelmed

230 Anne Eckman, “Beyond ‘The Yentl Syndrome’: Making Women Visible in Post-1990 Women’s Health Discourse,” p. 143, In Visible Woman: Imaging Technologies, Gender, and Science, eds. Paula A. Treichler, Lisa Cartwright, and Constance Penley, p. 130-168, New York and London: New York University Press, 1998.

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discussions of women’s reproductive risk. Advocates believed that women’s

reproduction, particularly their procreative capacity and caregiving responsibilities, could

and should be accommodated. While the FDA decision ultimately left the concept of

reproductive risk intact and burdened women with managing that risk, centering

advocacy that challenged this logic serves as a reminder that reproduction does not have

to be an individual burden—that is a structural and ideological choice.

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CHAPTER THREE

“Prisoner-Mothers” and the Politics of Women’s Incarceration and Rehabilitation, 1970-1990

Introduction

In 1971, the American Friends Service Committee (AFSC) published Struggle for

Justice: A Report on Crime and Punishment in America.231 Authored by a group of

Quaker Friends deeply entrenched in prisoners’ rights work, some of whom also brought

their own experiences of incarceration to the project, Struggle for Justice was a wholesale

indictment of the criminal justice system. Part confessional, part systematic evaluation,

the Friends’ report aimed to intervene in a national conversation torn between fear of

rising crime rates and concern about the state of America’s prisons and jails. Like other

prison reform and prisoners’ rights activists of the time, the AFSC had become convinced

that the criminal justice system was merely an extension of an inherently unjust society;

no amount of reform within prisons, courtrooms, or probation offices could salvage the

system as long as vast racial and economic inequity defined larger society. “To the

extent, then, that equal justice is correlated with equality of status, influence, and

economic power, the construction of a just system of criminal justice in an unjust society

is a contradiction in terms.”232

231 AFSC is a Religious Society of Friends organization. Friends are more popularly known as Quakers. 232 American Friends Service Committee, Struggle for Justice: A Report on Crime and Punishment in America, Hill and Wang, Inc. New York, 1971, p. 16.

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Of the contradictions inherent in America’s system of punishment, none was more

offensive to the AFSC than the idea that criminality was a personal characteristic, one

that could be treated through various methods of rehabilitation. With compassionate yet

critical self-awareness, the Friends attacked the logic of their nineteenth-century

forebears who worked to improve prisons through institutional reforms aimed at treating

individual criminality. Insisting “punishment should fit the criminal, not the crime,” well-

intentioned reformers had ushered in a dangerous conflation of punishment and welfare

whereby “the punitive spirit” of corrections “has survived unscathed behind the mask of

treatment.”233 What had begun as an effort to coercively assimilate immigrants, the poor,

and Blacks through punishment capable of treating the “total needs” of the offender in the

latter half of the nineteenth century had largely remained intact. Friends considered “the

systematic discrimination in criminal justice administration against minorities, sub-

cultures, and fringe groups” as evidence of the system’s racist and xenophobic origins.

The tool by which such discriminatory practices were made possible was the Friends’

ultimate object of derision: indeterminate sentencing.234 Indeterminate sentencing could

only be defended through the treatment principle; judges and parole boards needed to

adjust their decisions according to the whole individual, not only her crimes. Having

thoroughly rejected the logic that prisons could or should administer treatment, AFSC

joined the call for an end to indeterminate sentencing and a return to the retributive

function of punishment concerned solely with the crime committed. “When we punish

233 Ibid, p. 26-27. 234 Ibid, 29-31.

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the offender and simultaneously try to treat him, we hurt the individual more profoundly

and more permanently than if we merely imprison him for a specific length of time.”235

A year after the Friends’ released Struggle for Justice, the New York-based

Women’s Prison Association (WPA) published “A Study in Neglect: A Report on

Women Prisoners.”236 Having worked with “women in conflict with the law” since 1845,

the WPA was no stranger to the issues facing women in prison. Yet, like many other

organizations and individuals invested in advocating for this minority prison population,

the WPA was deeply concerned that women prisoners were not getting the attention and

support they deserved from criminal justice employees and governmental officials.

Frustrated by the oft-repeated argument that the number of female prisoners was

insufficiently small to warrant an increase in resources, “A Study in Neglect” aimed to

put the female offender on the map, especially for “male officials in the criminal justice

system” who “regard the problems of female offenders as insignificant.”237 The report

offered local and national statistics on incarcerated women and detailed women’s

marginalization with regard to funding streams, work furlough programs, and even the

availability of correctional facilities.

For the WPA, addressing the gap in knowledge about the female offender was

made all the more urgent by the rising rates of female crime, which appeared to be

outpacing the rise in crimes committed by men. “A Study in Neglect” made sure to

emphasize this threat in its recommendations. “Since female crime is increasing, an all

out effort should be made to reduce the recidivism rate before the female prison

235 Ibid, 147-148. 236 “A Study in Neglect: A Report on Women Prisoners,” prepared by Omar Hendrix for the Women’s Prison Association, July 15, 1972-Oct 15, 1972. 237 Ibid, 1.

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population becomes even greater.” In addition to calling for more research on the female

offender, the report advocated for “intensified rehabilitative efforts aimed at this smaller

group.” Despite acknowledging that “prisons do not deter, nor do they rehabilitate,” the

WPA called for more—not less—treatment initiatives premised upon “a recognition of

individual needs.”238 A far cry from the Friends wholesale abandonment of the treatment

principle, the WPA concluded by calling on public and private groups to come together

and “win support for reform and alternative means of assisting female offenders.”239

In this chapter, I examine the arrival of renewed concern about the female

offender in the context of what some have called the “punitive turn”—the bipartisan

abandonment of rehabilitation as either a responsibility or goal of corrections and the

subsequent embrace of mass imprisonment as the solution to crime.240 I ask how a

consideration of advocacy concerned with incarcerated women changes dominant

narratives detailing the emergence of a harsher, punishment-driven penology during the

1970s and 1980s. At the same time that liberal and radical prison reformers and

criminologists were calling for a return to retributive punishment in order to maintain

some semblance of justice, those championing the plight of the female offender did so by

painting a picture of the structural conditions defining incarcerated women’s lives.

Whereas the Friends’ manifesto rejected the idea that the punishment should fit the

criminal, not the crime, advocates for women in prison cared far more about the causes of

the female offender’s criminality than her crimes. As such, I argue that what David

Garland has described as “the collapse of faith in correctionalism” relies on a timeline

238 Ibid, 41-43. 239 Ibid, 44. 240 See The Punitive Turn: New Approaches to Race and Incarceration, Eds. Deborah E. McDowell, Claudrena N. Harold, Juan Battle, University of Virginia Press, 2013.

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that excludes debates, policy initiatives, and advocacy related to women in prison.241

Mobilization on behalf of the female offender offers the opportunity to revisit the

scholarly consensus that the majority of treatment-oriented criminal justice programs

were characterized as failures.242 This chapter traces the alternative story that emerges

when the problem of female incarceration—as articulated by advocates for women in

prison—is placed at the center of crime and punishment debates taking place during the

1970s and 1980s.243

Rather than abandon the criminal justice system’s responsibility to rehabilitate

those it punished, advocates for incarcerated women thoroughly embraced the treatment

principle and argued that women’s greater rehabilitative potential might hold the key to

penal reform. While male prisoners, prisoners’ rights activists, and liberal reformers used

the failure of rehabilitation to indict what they considered an inherently unjust system,

female prisoners, considered more dependent and less prone to riots and legal self-

advocacy than their male counterparts, were presented as promising subjects for testing

241 David Garland, The Culture of Control: Crime and Social Order in Contemporary Society, University of Chicago Press, 2001, p. 61. 242 Ibid, 61. Professor of medicine and liberal reformer David Rothman coined the “failure model,” and he was a vocal advocate for abandoning the rehabilitative model and turning to determinate sentencing. For a thoughtful reflection on how his and others views unintentionally helped along the punitive turn in American criminal justice see David J. Rothman, “The Crime of Punishment,” New York Review of Books, February 17, 1994. 243 This chapter is really about advocacy efforts that took place on behalf of women in prison rather than prisoner activism. While the last section on Prison MATCHoffers the perspective of prisoners involved in the program, the voices of prisoners are largely absent. When possible, I try to show the ways that some of the frameworks used by advocates diverged from those articulated by women in prison, whilst keeping in mind Regina Kunzel’s point that the “circulation of knowledge” regarding prison experience is far more fluid than a rigid “model of inside versus outside” suggests.243 But for the most part, this chapter examines discourse and reform efforts created by advocates who turned their attention to women in prison, and in the process shaped the contours of the “female offender” and maternal incarceration against a landscape of gender, race, poverty, and punishment. See Regina Kunzel, Criminal Intimacy: Prison and the Uneven History of Modern American Sexuality, University of Chicago Press, 2008, p. 10.

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prison’s rehabilitative potential.244 The WPA was not alone in its belief that testing

rehabilitative methods on the smaller population of women would likely “lead to

improved methods which benefit the entire prison population.”245 During public hearings

on the female offender convened by the D.C. Commission on the Status of Women in

1971, Congressman Walter Fauntroy suggested that innovation in treatment on behalf of

women prisoners could benefit all penal institutions.246 Lawyers turning their attention to

female prisoners’ rights agreed. Writing in 1973, Helen E. Gibson argued that adequate

attention to female prisoners would turn the tide on rehabilitation. “If the treatment model

can be effective at all, it can be effective with women.”247

While this proposition was used to advocate for all types of rehabilitation

programs generally lacking in women’s correctional facilities, ranging from vocational

training to law libraries to work furlough programs, I show how motherhood emerged to

hold the greatest rehabilitative promise of all. Through research, policy, and other types

of advocacy, the maternal suffering caused by incarceration came to define women’s

experience of confinement at the same time that it drove reform efforts. Highlighting the

fact of women’s primary caretaking responsibilities forced correctional officers and

institutions to consider the life—or, at the very least, the reproductive life—of the female

244 Despite the deeply sexist and outdated criminological theories about female criminals’ pathological dependency, some advocates argued that women’s dependence would make them more amenable to rehabilitation methods. For a critical account of the sexism influencing dominant theories of female criminality see Dorie Klein, “The Etiology of Female Crime: A Review of the Literature,” p. 5-31, in The Female Offender, Ed. by Laura Crites, Lexington Books, Lexington, MA, 1976. For an analysis of how social science research concerned with kinship networks formed by women in prison overshadowed female prisoners’ activism, including prison riots, see Juanita Diaz-Cotto, Gender, Ethnicity, and The State: Latina and Latino Prison Politics, State University of New York Press, 1996, p. 5. See also Victoria Law, Resistance Behind Bars: The Struggles of Incarcerated Women Second Edition, PM Press, Oakland, 2012. 245 “A Study in Neglect,” p. 41. 246 Congressional Record, House of Representatives, Vol. 118, No. 82, May 22, 1972, E5535-E5541. 247 “Women’s Prisons: Laboratories for Penal Reform,” Helen E. Gibson, Wisconsin Law Review 210 (1973): 229.

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offender beyond the crime that landed her behind prison walls. The case of incarcerated

women who were also mothers most directly challenged reformers’ calls to make

punishment fit the crime rather than the criminal’s unique circumstances; for incarcerated

mothers these circumstances meant the safety and well-being of their children. As one of

the staff of the federal program Prison Mothers and Their Children (MATCH) put it,

“The inmate-mother cannot be viewed in isolation, but must be seen in the context of her

life and role with her dependent children.”248

The rehabilitative potential of motherhood came from an unlikely source, and I

trace how advocates working in the 1970s re-purposed research on women in prison

conducted in the 1960s that was primarily concerned with women’s lesbianism and

women’s deluded self-concepts that they were adequate mothers. The shifting contours of

knowledge production on maternal incarceration quickly took on a life beyond the

scholarly study of the incarcerated mother, as advocates framed mothering from behind

bars in the language of women’s rights, children’s rights, and generational criminality

just as often as they invoked its rehabilitative potential. I highlight the competing

attachments to motherhood that at times won reforms for incarcerated women and their

children even as they reinforced essentialist, romanticized, and even coercive ideas about

mothering. Throughout, I try to keep major developments in the administration of

criminal justice that occurred during this period insight, both to show how these

developments affected women in prison and to reveal the ways gendered appeals to

rehabilitation, particularly motherhood, sometimes produced results that are surprising

248 Prison Match, “An Overview of the Pleasanton children’s center Program,” Sponsored by NCCD, n.d. p. 1.

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given the dominant narrative about crime and punishment in the United States during the

1970s and 1980s.

Ultimately, I find the various modes of invoking motherhood in the context of

prisoner advocacy important because they represent moments in which mothers typically

considered “unfit” by the state and the culture at large were contemplated as being

otherwise and when corrections was forced to confront the reproductive labor crisis harsh

sentencing policies were producing. As advocates have consistently argued since the

1970s, the incarceration of women results in the loss of a child’s primary caretaker far

more often than when men are incarcerated. This chapter explores how the carceral state,

when directly confronted with the reproductive labor of its rapidly increasing “minority

population,” responded with disavowal and reproductive neglect.

The Crisis in Rehabilitation and the “Forgotten Offender”

Those writing about the failure of the treatment model of incarceration during the

1970s were often motivated by direct participation in or solidarity with prisoner activism

against unjust conditions of confinement and the broader civil rights movement.249

Emanating largely from political and research advocacy based in New York and

California, those authoring formal indictments of the criminal justice system were also

influenced by the political protest of the 1960s and had profound skepticism about the

ability of state institutions to treat its citizens equally and fairly, much less provide

249 For an examination of the relationship between Black prisoner activism and the civil rights movement see Dan Berger, Captive Nation: Black Prison Organizing in the Civil Rights Era, University of North Carolina Press, Chapel Hill, 2014.

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welfare to those in need.250 In the aftermath of the Attica prison riots, many brought this

skepticism to their consideration of what seemed to be an undeniable crisis in the

conditions of imprisonment in the United States

In addition to self-published studies such as AFSC’s Struggle for Justice, expert

criminologists and sociologists were also called upon to evaluate the criminal justice

system. For example, the committee for the Study of Incarceration was convened by the

Field Foundation to investigate the state of incarceration in 1971, shortly after the riots at

Attica. Five years later, their report Doing Justice transparently presented their critical

approach to the question of state-sponsored rehabilitation. “If Progressive reformers

shared a basic trust in the state, more eager to involve its power in the society than to

limit it, we as a group shared a basic mistrust of the power of the state.”251 This report

joined the chorus of despondency over the viability of welfare penology, and supported

the solution of determinate sentencing based on the crime rather than the needs of the

unique individual. Less inflected with leftist skepticism but considered equally

devastating, major literature reviews analyzing the existing research on rehabilitation

were also published during this period. Despite their more measured tone, their finding

that there was very little research proving the efficacy of any kind of treatment program

further fueled the sentiment that faith in a welfare-oriented correctional system was

dangerously misguided.252

250 Sociologist Erving Goffman’s work on mental asylums, for example, had popularized the debilitating psychological effects of confinement through his concept of the “total institution.” 251 Doing Justice: The Choice of Punishments—The Report of the Committee for the Study of Incarceration, Andrew Von Hirsch, Hill and Wang: New York, 1976, p. xxxii. 252 These reports analyzed existing research on rehabilitation programs and found the majority of studies to be rife with methodological issues. See The Effectiveness of Correctional Treatment: A Survey of Treatment Evaluation Studies, Douglas Lipton, Robert Martinson, Judith Wilks, Praeger Publishers, New York, 1975; The Rehabilitation of Criminal Offenders: Problems and Prospects, Eds. Lee Sechrest, Susan

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When it came to women in prison, however, the problem was not the system’s

inherent contradiction. According to advocates, it was the fact that women had been

completely overlooked and neglected by the system—they had yet to enjoy a real

opportunity at rehabilitation due to lack of funding and programs directed towards their

needs. In state and federal prisons as well as jails, women consistently had less access to

all types of rehabilitative programs, including educational, vocational, recreational, and

visitation. Due to women prisoners’ much smaller numbers, many states lacked separate

women’s facilities, often leaving women prisoners confined to small, segregated sections

of male facilities.253 A national study funded by the U.S. Office of Education in 1975

reported eight vocational programs for women compared to fifty-eight for men.254

Perhaps most symbolic of the status of women prisoners was the failure of the Johnson

Administration’s 1967 The Challenge of Crime in a Free Society to address women in the

criminal justice system beyond briefly mentioning them as a special population. At the

Fourth Annual Forum of Volunteers in Criminal Justice dedicated to “Women in Prison,”

Mary Louise Cox summed up advocates’ concerns about the dearth of attention to

incarcerated women. “The plight of both short-term and long-term women offenders in

the United States has been overlooked. Incarceration, in spite of its high cost, provides no

O. White, Elizabeth D. Brown, National Academy of Sciences, Washington D.C., 1979. As David Garland has pointed out, the conclusion of these reports—that the majority of treatment programs were being administered without sound evidence that they worked—morphed into a much more devastating conclusion that all reform efforts aimed at treatment had failed. Garland argues that this more extreme conclusion was not warranted by the literature reviews of existing research, but was instead motivated by total disillusionment with the state, Garland, The Culture of Control, p. 69, 71. 253 For example, in 1970 less than one percent of state and federal prisoners were women. Barbara Allen Babcock, “Introduction: Women and the Criminal Law,” The American Criminal Law Review, Vol. 11, No. 2, Winter 1973, p. 292. 254 Mary Louise Cox, Judith Glazer, Sister Elaine Roulet, “Women in Prison,” VIP Examiner, Summer 1975, ACLU Prison Project Papers, Box 2999, Folder “Update-Prison Book,” Mudd Library, Princeton University.

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real opportunity for women to be reintegrated into their communities, which are in reality

all of our communities.”255

For many advocates, the inattention to female prisoners’ needs stemmed from the

fact that the majority of criminal justice officials were men and reflected the broader

reality of women’s subordinated status in society. The oft-repeated explanation that

women made up too small a proportion of offenders to justify additional resources

especially angered advocates. In a letter to the Director of Corrections for the Law

Enforcement Assistance Administration (LEAA) Ken Carpenter, feminist attorneys in

New York challenged this logic. “Despite the presently comparatively small number

there are many reasons why we and a growing number of people believe that some

special attention must be given to the women, and in particular to the unique problems

they have. Indeed, it is their relatively small number that has caused them to be the

forgotten segment of the prison population and has deprived them of the new benefits

being given male prisoners.”256 Putting it more bluntly, one advocate wrote, “Prisons in

the past have not been considered a female problem; the system has been run by men,

primarily for men.”257

Yet it was not only criminal justice officials that ignored women in prison.

Advocates also accused prisoners’ rights and women’s liberation activists of overlooking

the plight of incarcerated women. The founders of the Women’s Prison Project, a legal

education program initiated at Bedford Hills correctional facility in New York in the

early 1970s, described this advocacy gap. “Recently, there has developed an increasing 255 Ibid. 256 Letter to Ken Carpenter from Marilyn G. Haft, Barbara Swartz, Polly Feingold, Jan 7, 1974, p.2, ACLU Prison Project Papers, Box 2999, Folder “Women in Prison,” Mudd Library, Princeton University. 257 Linda R. Singer, “Women and the Correctional Process,” The American Criminal Law Review 11(2): Winter 1973, p. 295.

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concern for the problems of women and for the problems of prisoners. Unfortunately,

these concerns have rarely been combined. Women prisoners have been neglected even

by the women’s rights and the prisoners’ rights movements.”258 Founders of the National

Resource Center on the Female Offender agreed. “Forgotten by both the prisoner’s rights

groups and the women’s movement, life for women offenders has changed little in the

last several decades.”259

In order to remedy this neglect, advocates for women in prison made gendered

appeals to rehabilitation initiatives, particularly programs that diverted women from

incarceration altogether. Writing in 1973, Executive Director of the Center for

Correctional Justice Linda R. Singer acknowledged, “Efforts to protect the legal rights of

women who are in prison must be coupled with efforts to develop alternatives to the

present system. It has been pointed out by a few observers that the system of

imprisonment for females should be easier to tear down and replace than that for males,

since there are far fewer women and they generally are considered non-violent.”260

Similarly, an article outlining the issues facing women prisoners concluded “the true

interests of female prisoners may best be served by efforts aimed at deinstitutionalization

258 Funding Proposal: Women’s Prison Project,” Prepared by Michele Hermann and Marilyn G. Haft, n.d. p. 1, ACLU Prison Project Papers, Box 3143, Folder “Bedford Hills,” Mudd Library, Princeton University. Given that women also suffered the effects of indeterminate sentencing, it would seem that this accusation might also extend to the prison reformers who saw rehabilitation as the vehicle by which discriminatory sentencing practices were able to thrive. For a thorough discussion of indeterminate sentencing laws and women see Carolyn Temin, “Discretionary Sentencing of Women Offenders,” American Criminal Law Review 11, 1973: 357-361. Of the major publications calling for an end to the treatment Struggle for Justice was the only one to include a brief section on women discussing their general unequal status under the law, p. 114-117. 259 The Woman Offender Report, Vol.1, No. 1, March/April 1975, p. 1, ACLU Prison Project Papers, Box 2999, Folder “Women’s National Resource Center,” Mudd Library, Princeton University. 260 Linda R. Singer, “Women and the Correctional Process,” The American Criminal Law Review 11(2): Winter 1973, p. 307.

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rather than parity with men.”261 Indeed, nearly every recommendation issued by

advocacy groups during this period called for both increased rehabilitation programs and

alternatives to incarceration. So great was the belief in rehabilitation’s potential for

women that one study on the almost nonexistent rehabilitative infrastructure in

Pennsylvania’s facilities for women asked “If county jails and prisons cannot serve a

rehabilitative purpose, then what is their function?”262

While this growing network of advocates had a shared vision of the solution to

women who were also offenders, this vision was decidedly in the minority and advocates

faced a formidable challenge garnering support. This was not only because of criminal

justice officials’ lack of interest in incarcerated women, but also because popular

discourse on the female offender was not at all reflective of advocates’ visions. At the

same time advocates turned their attention to women in prison, so too did the media.

Capitalizing on the nation’s growing obsession with crime and safety as well as its

voyeuristic relationship to the women’s liberation movement, media outlets began

publishing what was meant to be an alarming statistic—female arrest rates had far

outpaced male arrests between 1960 and 1972.263 Even before criminologist Freda

261 Sharon L. Fabian, “Toward the Best Interests of Woman Prisoners: Is the System Working?,” New England Journal on Prison Law, 6(1), Fall 1979, 1-60, p. 60. 262 Report on the Survey of 41 Pennsylvania County Court and Correctional Services for Women and Girl Offenders Jan 1, 1965-Dec 31, 1966,” Report submitted by Margery L. Velimesis, Division Project Director of the Pennsylvania Division of American Association of University Women, n.d., p. 6. 263 “Women Heading for Equality with Men—in Field of Crime,” Arleen Abrahams, Los Angeles Times, August 11, 1969; “Crime Rate of Women Up Sharply Over Men’s,” Steven V. Roberts, NYT, June 13, 1971; “Women in the Struggle,” R.B., The Guardian, July 7, 1971,” Crime, Prisons, and Reform Schools Papers, Box 1, Folder “Crime-Clippings, Sophia Smith Collection, Smith College; “Female Crime Discrepancy,” Mary Barber, Los Angeles Times, June 29, 1972; “A Close Look at Women and Crime,” Sheila Wolfe, Chicago Tribune, January 7, 1973; “Sharp Increase in U.S. Crime by Women,” The London Observer, Joyce Egginton, n.d., ACLU Prison Project Papers, Box 3143, Folder “Institute on Women’s Wrongs, 1974,” Mudd Library, Princeton University; “More and More, Baby, the Rap is Murder,” Kitty Hanson, Daily News, June 19, 1974, Crime, Prisons, and Reform Schools Papers, Box 1, Folder “Crime-Clippings, Sophia Smith Collection, Smith College; “Female Crime Wave All but Ignored,” Associated Press, Los Angeles Times, November 27, 1975.

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Adler’s widely publicized Sisters in Crime popularized the link between female

criminality and the women’s liberation movement in 1975, reports citing the FBI statistic

explained to readers that the drastic rise in crimes committed by women was the result of

shifting gender roles.264 In a 1971 New York Times article, a Los Angeles County sheriff

explained, “As women emerge from their traditional roles as housewife and mother,

entering the political and business fields previously dominated by males, there is no

reason to believe that women will not also approach equality with men in the criminal

activity field.”265 Some lawyers representing women agreed. A staff attorney for the

National Prisoners’ Rights Project in Washington D.C. described how crimes by women

were escalating in severity. “It might be a case of embezzlement where it used to be petty

larceny, but then women are only just beginning to get into business positions where they

have the opportunity to embezzle. Men have been doing it for years.”266 Criminologists

and sociologists legitimated firsthand accounts from law enforcement and attorneys.

Professor Marvin Wolfgang, Freda Adler’s adviser at the University of Pennsylvania,

warned of women becoming “more aggressive personalities” as the infrastructure of

chivalry and protection that kept women passive was dismantled by feminism.267 So great

was the desire to attribute crime to women’s liberation that some reports offered bizarre

264 Meda Chesney-Lind attributes the link between women’s crime and women’s liberation to books by Freda Adler and Rita James Simon. I simply am tracing the emergence of this association prior to these publications, but these books, particularly Adler’s, no doubt further publicized the connection. For a thorough accounting of the ways female criminality has been constructed as a consequence of women’s emancipation and the many studies that have refuted this link since the 1980s, see Meda Chesney-Lind, “Women and Crime: The Female Offender,” Signs, 12(1): 1986, p. 78-96. For a thorough analysis of how the widely circulated FBI statistic provided a misleading picture of female criminality and women’s social role see, Darrell J. Steffensmier, “Sex Differences in Patterns of Adult Crime, 1965-1977: A Review and Assessment,” Social Forces, 58(4), June 1980, p. 1080-1108. 265 “Crime Rate of Women Up Sharply Over Men’s,” Steven V. Roberts, NYT, June 13, 1971. 266 “Sharp Increase in U.S. Crime by Women,” The London Observer, Joyce Egginton, n.d., ACLU Prison Project Papers, Box 3143, Folder “Institute on Women’s Wrongs, 1974,” Mudd Library, Princeton University. 267 “Crime Rate of Women Up Sharply Over Men’s,” Steven V. Roberts, NYT, June 13, 1971.

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calculations that unintentionally supported increased rights for women. “Some experts

have noted that violent crimes committed by women used to be of a different kind. A

desperate woman might murder her husband or her unwanted child, but now she can get

rid of one by divorce and the other by abortion. So the violent crimes of womanhood are

now less likely to be passionate, and more likely to be economically motivated.”268 By

1975, the United Nations had declared the increasing crime rate among women “a new

universal phenomenon” resulting from women being “provided with opportunities

traditionally reserved for males.”269

In this way, the white, educated, middle-class housewife and/or New Left activist

presumed by the public to be the quintessential instigator of women’s liberation also

became the quintessential female offender. Given public assumptions about what kinds of

women were feminists, it is not surprising that the crimes supposedly being committed by

a new wave of female criminals mapped onto the most commonly imagined and

sensationalized crimes—murder, bank robbery, and embezzlement. In order for the link

between female criminality and women’s liberation to work, media outlets had to

highlight stories of women committing more “male-dominated” crimes, despite the fact

that petty theft and check or welfare fraud—traditionally female crimes—continued to

explain the vast majority of female arrests indexed by the FBI Uniform Crime Reports.270

Journalists discussed Patty Hearst alongside female members of the Weather

Underground to strengthen the link while drawing a picture of the typical “liberated”

268 “Sharp Increase in U.S. Crime by Women,” The London Observer, Joyce Egginton, n.d., ACLU Prison Project Papers, Box 3143, Folder “Institute on Women’s Wrongs, 1974,” Mudd Library, Princeton University. 269 Aided, of course, by Freda Adler’s consultant work. “Women Gaining Equality in Crime,” Scott Thorton, Boston Globe, September 3, 1975; “Female Crime Rate Soars Worldwide, U.N. Reports,” Associated Press, Los Angeles Times, May 14, 1975. 270 Steffensmier, p. 1093-1097.

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female criminal.271 Even famed anthropologist Margaret Mead helped stoke hysteria

about the potential chaos that could result from women’s libbers taking up arms. “The

biological bases of aggression between the two sexes may differ significantly. Women

may be without the built-in checks on murder that are either socially or biologically

present in males.”272

While some advocates working with women offenders subscribed to the argument

about women’s liberation, the vast majority went to great lengths to dispel this theory as

well as its inverse—the “chivalry thesis.” 273 Those working in law enforcement,

corrections, and the field of criminology had long claimed that male police, prosecutors,

and judges who “hate to accuse women” treated them more leniently than men, and the

belief was still alive and well in research concerned with the “female offender.”274 A

1968 study explained, “The differential law enforcement handling seems to be built into

our basic attitudes toward women. The operation of such attitudes can be called,

euphemistically, the chivalry factor.”275 Former president of the American Correctional

271 Kitty Hanson, “Wild Women: No Innter Checks?” Daily News, June 18, 1974, Crime, Prisons, Reform Schools, Box 1, Folder “Crimes/Criminals/Prisons Clippings,” Sophia Smith Collection, Smith College. 272 Ibid. 273 In addition to attorneys quoted by the media, the WPA’s “A Study in Neglect” suggests that “female crime will increase in direct proportion to the increase in emancipation,” p. 5. For a typical example of studies that uncritically accepted this link see also “Women in Prison: An Awakening Minority,” Phyllis Jo Baunach and Thomas O. Murton, Crime and Corrections, 2(1), Fall 1973, p.4-12. 274 Otto Pollak, The Criminality of Women, (Philadelphia: University of Pennsylvania Press, 1950), p. 151, quoted in Meda Chesney-Lind, “Chivalry Reexamined: Women and the Criminal Justice System,” in Women, Crime, and the Criminal Justice System, Ed. Lee H. Bowker, Lexington MA: Lexington Books, 1978. In this article, Chesney-Lind also debunks the chivalry thesis, showing how it typically only benefited women who confirmed law enforcement’s ideas of traditional womanhood and femininity through both the type of crime committed and individual characteristics such as being married, presenting feminine, and being white. For a thorough overview of the way the chivalry thesis was widely accepted by those working in criminal justice see Etta A. Anderson, “The Chivalrous Treatment of the Female Offender in the Arms of the Criminal Justice System: A Review of the Literature,” Social Problems 23 1976, p. 349-357. 275 Reckless and Kay, The Female Offender, quoted in “Women and the Correctional Process,” Linda R. Singer, in A Symposium: Women and the Criminal Law, The American Criminal Law Review 11(2): Winter 1973, p. 296.

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Association Martha Wheeler also attributed the chivalry factor to men’s inherent inability

to punish women. Speaking at a conference on the “female offender” in 1974, she told

audience members, “You are all aware that law enforcement agencies are largely male—

prosecutors are mostly male, judges are mostly male—and the attitudes are inclined to be

that gentle woman could not possibly have been involved in this behavior. Women have a

good many more escape hatches and receive a good deal more forgiving.” 276

As attention to the female offender increased in the early 1970s, the chivalry

thesis took on a dual significance. Those interviewed in media stories about rising crime

rates argued that women’s liberation had reached law enforcement officials who were

enacting gender equality by arresting and prosecuting women just as they would men.

Sociologist Richard Block surmised, “As women become more liberated and perhaps

more aggressive, they lose some of the protection they had from our criminal justice

system. They are being treated more like men.”277 At the same time, in the rare occasions

criminal justice officials actually acknowledged the female population of incarcerated

persons, they often touted corrections’ gendered benevolence. This quickly became a

stumbling block for advocates looking to build momentum around female prisoners’

rights. Every time the chivalry factor was invoked, it minimized women’s actual

experiences of jail and prisons and made the widely shared belief that more support and

funding was needed for rehabilitative programs at women’s facilities seem hollow.

Advocates hoped to counter ideologically driven stereotypes with facts,

particularly facts about the women who had not benefited from the alleged benevolence

276 Martha Wheeler, “The Current Status of Women in Prisons,” p. 85, in The Female Offender, Ed. Annette M. Brodsky, Sage Publications Inc., California and London, 1977. 277 Sheila Wolfe, “A Close Look at Women and Crime.”

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of law enforcement officers and judges and were serving time as a result.278 Studies, like

the WPA’s, which attempted to collect basic demographic data about women in prisons

and jails served as an entry point into debates over crime and prison reform for many

gender-based advocates during this period. State-level women’s commissions in the

District of Columbia, Pennsylvania, Massachusetts, and California turned their attention

to the female offender by holding public hearings and commissioning or supporting

reports. Churchwomen United and the Florida League of Women Voters did the same.279

While some reports were more critical of the chivalry thesis than others, most agreed that,

much like the criminal justice system itself, chivalric benevolence was likely unevenly

applied based on race, class, and type of offense.280 The D.C. Commission on the Status

of Women noted that “officials in the system” make decisions that “tend to favor the

white middle class,” a fact reflected in the disproportionate number of Black women in

278 For example, the idea that the success of a movement dedicated to the woman offender had been “hampered by both lack of information and misinformation” was the driving force behind the creation of the National Resource Center on Women Offenders, whose slogan was “Dedicated to increasing public awareness of the problems of the woman offender and working on reforms in her behalf.” The Woman Offender Report, Vol.1, No. 1, March/April 1975, p. 1, ACLU Prison Project Papers, Box 2999, Folder “Women’s National Resource Center,” Mudd Library, Princeton University. 279 See “Female Offenders in the District of Columbia,” Congressional Record, May 22, 1972, p. E 5535-5541; “From Convict to Citizen: Programs for the Woman Offender,” District of Columbia Commission on the Status of Women, June 1974; “Education Task Force Report: The Female Offender,” Massachusetts Governor’s Commission on the Status of Women, by Kay Bourne, 1972, Crime, Prisons, Reform Schools, Box 1, Folder “Prisons/Prisoners,” Sophia Smith Collection, Smith College; Mary Louise Cox, Judith Glazer, Sister Elaine Roulet, “Women in Prison,” VIP Examiner, Summer 1975; The Pennsylvania Commission on the Status of Women was supportive of Pennsylvania Program for Women and Girl Offenders’ (PPWGO) efforts to produce state-funded community treatment centers as an alternative to incarceration. See PPWGO newsletter News, Resources, and Research Series 1, No. 1 and The CSW Report, April 9, 1973, Crime, Prisons, Reform Schools, Box 1, Folder “Penn Program for Women and Girl Offenders,” Sophia Smith Collection, Smith College. 280 In the later part of the decade, feminist sociologists and criminologists would not only disprove the chivalry thesis, but offer a much more complicated assessment. If sex-based discrepancies in sentencing occurred, it was much more likely to depend on how well women conformed to the sex-based roles expected by police and judges. This could include the type of crime or other aspects of women’s lives, such as marital status or prior record. See Meda Chesney-Lind, “Chivalry Reexamined: Women and the Criminal Justice System,” p. 215-217.

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the D.C. Women’s Detention center.281 Speaking at the public hearings organized by this

same Commission, Director of the Women’s Bureau of the U.S. Department of Labor

Elizabeth Koontz testified, “Most women offenders come from the city ghettos. A

disproportionate number are from minority populations…they are poor—very poor.”282

The Pennsylvania Program for Women and Girl Offenders (PPWGO)’s report on court

and correctional services in all forty-one counties in the state also found that age, race,

and marriage influenced type of offense charged, with Black women, young women, and

unmarried women receiving harsher charges for similar crimes.283 Legal advocates

involved in prison reform and women’s rights also drew on experiential evidence to

dispel the chivalry thesis, arguing that “anyone who has spent time in women’s prisons

would agree that they are not institutions for the rich.”284 Executive Director of the

PPWGO Margery L. Velimsis agreed. “The fact is, that women who commit crimes do so

for money. And it is poor women who are in our prisons—untrained, family-supporting,

poor women.”285

Fueled by newly collected data and their own experience working directly with

women and jails, advocates also took on the link between feminism and female

criminality, particularly as Freda Adler’s book became somewhat of cultural

phenomenon after 1975. In an editorial to the New York Times, director of Pittsburgh

281 “From Convict to Citizen,” p. 4-5. 282 Quoted in Linda R. Singer, “Women and the Correctional Process,” in A Symposium: Women and the Criminal Law, The American Criminal Law Review 11(2): Winter 1973, p. 297. 283 Report on the Survey of 41 Pennsylvania County Court and Correctional Services for Women and Girl Offenders Jan 1, 1965-Dec 31, 1966,” Report submitted by Margery L. Velimesis, Division Project Director of the Pennsylvania Division of American Association of University Women, n.d., p.17-19. 284 Linda R. Singer, “Women and the Correctional Process,” in A Symposium: Women and the Criminal Law, The American Criminal Law Review 11(2): Winter 1973, p. 296-297. 285 Inside/Outside Newsletter of Pennsylvania Program on Women and Girl Offenders, Vol. 2, No. 5, November 1975, p. 2, Sophia Smith Collection, Crime, Prisons, Reform Schools, Box 1, Folder “Penn Program for Women and Girl Offenders.”

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Services for Women Offenders Judy P. Hansen declared the connection ignorant. “To

those who actually deal with female offenders, the notion that the women’s movement is

pushing women into criminal behavior is sadly ironic. Anyone who has any contact at all

with women in the jails and prisons knows that there are few feminists behind bars.

Economic liberation and the means to be self-sufficient—major goals of the liberated

woman—elude women offenders.”286 At a 1976 conference on “Women and Crime” held

in Washington, D.C., conference-goers took Adler to task for popularizing what they

considered a misleading and harmful connection. Like Hansen, they did so by insisting

on the lack of feminist consciousness of offenders. Pauline Feingold of the New York

Urban Coalition said, “Women who get in trouble with the law are almost invariably part

of the most sexist and exploitive segment of society.287 Few of them are even aware of

the women’s liberation movement and what it means.” President of the National

Organization for Women (NOW) Wilma Scott Heide told those at the 1974 “Planning for

the Female Offender” conference at the University of Alabama “the most important thing

we can do for and with women in jail and within the criminal justice system is to teach

more assertive behavior…For some women, going to jail means that they are out of one

jail (psychological jail for many women if they have been limited to their roles and

opportunities) and into another.”288 The PPWGO’s newsletter Inside/Outside also tried to

offer its readership an alternative to the “kitchen knives have given way to pistols and

sawed-off shotguns” narrative.289 “Most proponents of the feminism-as-cause theory are

286 Judy P. Hansen, “Women’s Rights, and Wrongs,” NYT, March 17, 1975. 287 Tom Buckley, “Critics Assail Linking Feminism With Women in Crime,” NYT, March 14, 1976. 288 Wilma Scott Heide, “Feminism and the ‘Fallen Woman,’ p. 77-81, in The Female Offender, Ed. Annette M. Brodsky, Sage Publications Inc., California and London, 1977. 289 Quote from Dr. Ruth Rutschmann-Jaffe in “America Said to Face ‘Female Crime Wave,’” The Washington Post, Feb 25, 1976.

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so involved with statistics and trends they forget their person-to-person experience with

female offenders, which clearly demonstrate that there are few feminists behind bars.”290

A newly created pilot project of the American Bar Association, the National Resource

Center on Women Offenders, set the record straight in its first publication of The Woman

Offender Report. “The average woman in prison, however, has little of the consciousness

associated with the feminist movement. She is typically poor, has little education, and,

because she has few marketable skills, has concluded that ‘crime pays because nothing

else does.’”291

If the “liberated” woman was white, middle-class, educated, and aggressive, then

so too was the “liberated” female offender. This was the logic underpinning the debate

over female criminality, chivalry, and feminism. In order to dispel the myth of the

liberated criminal, advocates tried to introduce the American public to a more accurate

profile of the female offender—she was a poor, unmarried, uneducated minority. Her

criminality was a direct result of her oppression; hers were victimless crimes motivated

by extreme economic marginalization. While the degree to which an incarcerated

woman’s race, class, marital, and educational status indexed her feminist potential varied

amongst advocates, the majority used these characteristics to reject the link. In the

process, they made the “female offender” antithetical to the women’s libber, reinforcing

the raced, classed, and socioeconomic characteristics associated with each archetype.

Caught between criminal justice officials’ invocation of the chivalry thesis to

downplay women’s conditions of confinement and sensationalist claims about feminism

290 Inside/Outside Newsletter of Pennsylvania Program on Women and Girl Offenders, Vol. 2, No. 5, November 1975, p. 2, Sophia Smith Collection, Crime, Prisons, Reform Schools, Box 1, Folder “Penn Program for Women and Girl Offenders.” 291 The Woman Offender Report, Vol.1, No. 1, March/April 1975, p. 1, ACLU Prison Project Papers, Box 2999, Folder “Women’s National Resource Center,” Mudd Library, Princeton University

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and crime, advocates emphasized the raced, classed, and gendered powerlessness of the

female offender. The first publication of The Woman Offender warned “The myth of

feminism causing a new female role in crime provides a simplistic scapegoat which

allows obliteration of the primary reasons women commit crime and, as such, diverts

thought and energy away from eliminating the underlying economic and social causes of

crime.”292 Given the paucity of evidenced research about and commitment to incarcerated

women within criminal justice institutions, the inaccurate claims were all the more

destructive to a burgeoning movement bent on bringing women’s rights to criminal

justice reform. Still, the insistence on severing the “faulty connection” between feminism

and female criminality made feminist consciousness available only to liberated advocates

and reinforced the sexist and racist evaluations of female criminals that had characterized

criminology since the nineteenth century, all the while buying into the media’s caricature

of feminism. “They (female offenders) define themselves as wives, mothers, and

girlfriends—not feminists,” said Velimsis. This position rebutted the link between

feminism and female criminality. It also laid the groundwork for appeals to the

rehabilitative potential of motherhood.

Producing Maternal Incarceration

The notion that women were more amenable to rehabilitation was largely based

on a socio-political context of women’s role. Advocates looked not at the crime itself, but

the context in which the crime was committed, emphasizing the various forces that drove

women to crime. More often than not, economic marginalization was the answer, hence

292 Ibid, p. 3.

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the profile of the poor, uneducated, unmarried offender struggling to provide for

dependents in a marketplace where she had no skills to sell. Less often, advocates

gestured to the racial discrimination of law enforcement and courts to explain the

disproportionate numbers of Black women in prison. This marginalization was then

replicated during women’s incarceration. Advocates agreed that women’s exclusion from

vocational training available to men in prison was one of the most hypocritical aspects of

discrimination—corrections was basically asking for women to recidivate. When the only

vocational programs offered in women’s facilities were cosmetology and typing,

advocates’ belief that many correctional officials’ outmoded ideas about gender roles

blinded them to the realities of women’s lives grew even stronger.

Yet underneath a tendency to emphasize external factors when evaluating

women’s crimes were assumptions about basic differences between men and women.

Women were less violent, as evidenced by the types of crimes they committed. They

were more social and did worse in isolated prison facilities as a result, and were a better

candidate for community corrections and halfway houses as a result. They tended to be

more passive and dependent, especially when it came to men, which explained why they

were slow to protest their conditions of confinement or become involved with the law

because of male influence. Whether those concerned with women in prison believed

these characteristics to be innate or a product of socialization did not really matter; the

fact remained that much of the initiatives meant to better serve this population rested on

their perceived difference from the male prisoner—even when those initiatives simply

aimed to replicate the programs already available to men.

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The tendency to overlay gendered, raced, and classed presumptions about female

criminality with an analysis of external socioeconomic drivers of crime was especially

apparent in the research and initiatives related to maternal incarceration. Women in

prison and their advocates rightly pointed out the failure of corrections to account for

prisoners’ who were also the primary caretakers of children. Incarcerated parents and

their children fell through the cracks of corrections, the courts, and child services, not

only making for logistical nightmares in terms of childcare arrangements and visitation,

but often having the permanent effect of terminating parental rights due to inadequate or

non-existent legal aid upon imprisonment. The absence of any sort of protocol also

extended to women who were pregnant upon incarceration. Most facilities were ill

equipped and unwilling to address the health needs of pregnant women, much less create

plans for the infant after birth.

These institutional gaps produced lived pain and misery, and this emotional field

was difficult for advocates’ to navigate. The pain and heartache of incarcerated women

and their children could not be separated from a deep societal investment in motherhood

and belief in the exceptional nature of the mother-infant bond. Proposals to resolve the

singular pain of maternal incarceration were clearly informed by sentimental

constructions of motherhood, and reuniting women with their children emerged as a

potential rehabilitation strategy as or more important than vocational training and access

to legal resources. Women’s maternal status proved to be the most powerful means of

gendering corrections even though making prisons fit for mothers and children required a

continuation of the idea that prisoners’ were somehow lacking and in need of treatment.

While advocates used women’s socioeconomic status to counter the link between

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feminism and female criminality, when it came to motherhood, these markers receded to

the background, replaced by cultural arguments about women’s roles as caretakers.

In the mid-1960s, two studies aimed at investigating the differences between

men’s prisons and women’s prisons were published. Despite the fact that both of these

studies ended up focusing on the homosexual relationships they discovered in women’s

facilities, these studies would enjoy renewed attention in 1970s literature on maternal

incarceration that tried to make the case for keeping women and their children together.

In 1965, two sociologists at UCLA published a study of the largest women’s prison in the

country, the California Institution for Women, Frontera (CIW). Encouraged by the

superintendent, whose enthusiasm for opening her prison up for research was quite rare,

Ward and Kassebaum set out to “explicate the character of the pains of imprisonment

which women prisoners experience” as well as “the adaptations made to these

deprivations.”293 The sociologists spent much of the report’s 200 pages detailing

women’s “homosexual adaptation” in response to the pains of imprisonment. Both the

deprivations and the response of homosexuality, the study reported, mirrored the findings

of studies conducted in men’s prisons.294

However, Ward and Kassebaum made a cursory note of one pain that made

imprisonment more of a hardship for women than for men—separation from their

children. So severe was this “uniquely female deprivation” that the report recommended

293 David A. Ward and Gene G. Kassebaum, Women’s Prison: Sex and Social Structure, Aldine Transaction, New Brunswick and London, 1965, p. 2. The invocation of “pains of imprisonment” by Ward and Kassebaum references the influential works of Gresham M. Sykes, Society of Captives, 1958 who coined the term and Erving Goffman, Asylums, 1961 who popularized the idea of the ‘”total institution.” Both works prompted sociologists to consider the psychological and social effects of confinement on prisoners and those otherwise committed. 294 Ward and Kassebaum write “Sykes has delineated the painful conditions of confinement which male prisoners must bear…All these deprivations apply to female prisoners,” p. 28.

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separation of mother and child “only under extraordinary circumstances.”295 A year later,

a study of Alderson Federal Prison for women by sociologist Rose Giallombardo also

emphasized the creation of an informal social structure of kinship and homosexual

marriage by women prisoners. According to Giallombardo, not only was this social

network distinct from the deprivation response enacted in men’s prisons, but it was also

an attempt to recreate the social role women had performed prior to imprisonment—wife,

mother, and dependent caretaker.296 Studies that treated the prison as institutions

somehow hermetically sealed from the outside were misguided, argued Giallombardo.

Prisoners’ social roles prior to imprisonment were hugely influential to the strategies of

survival enacted once inside.297

While these studies ended up being most concerned with women’s sexually

“deviant” responses to the deprivation of being institutionalized, the superintendent of

CIW had also opened her prison to researchers with different questions. Prior to the

publication by Ward and Kassebaum, CIW hosted a team of researchers hoping to learn

more about the “female offender as mother” and her family, particularly the “ways in

which she might be helped to make her maximum contribution to the welfare of the

children even during the incarceration.”298 A collaboration between the State Department

295 Ibid, p. 14-15. This conclusion was attributed to the fact that when asked in a survey which aspect of prison life was most difficult to adjust to, the answer most often selected was “absence of home and family.” However, it is quite obvious, and argued by Kunzel, that researchers’ own ideas about traditional gender roles helped to elevate this concern. 296 Rose Giallombardo, Society of Women: A Study of a Women’s Prison, Jon Wiley and Sons Inc, New York, 1966. 297 In Giallombardo’s assessment, homosexual and kinship relations were more viable in women’s facilities precisely because there was already societal acceptance of affectionate friendship between women. In contrast, such social relations were not feasible in men’s facilities due to the ever present threat of being labeled feminine or homosexual if one strayed too far from the expected masculine behavior that defined American culture inside and outside the prison. 298 Serapio R. Zalba, “Women Prisoners and Their Families,” Delmar Publishing Company, Los Angeles, CA, 1964, p. 8.

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of Social Welfare and the State Department of Corrections, the study also set out to

assess “inter-agency cooperation” in the assistance of families affected by imprisonment

in light of a study from a decade prior that evidenced almost zero coordination between

state agencies.299

Similar to Ward, Kassebaum, and Giallombardo, the study led by researcher

Serapio Zalba found that “the role of the mother is more crucial for the mother herself

than is the father’s role to him, and that separation from her children…more directly

strike at her essential personal identity and her self-image as a woman.”300 Distinct from

the other studies focused on lesbianism, however, was the identification of an “inmate

value system” different from homosexual relationships.301 In the women’s prison,

“expressing concern about one’s children” was a “highly condoned activity,” with an

especially “high status” accorded to pregnant inmates.302 Yet, unlike Ward and

Kassebaum’s cursory recommendation that women not be separated from their children

as a result of this finding, Zalba and his team of researchers struggled to believe that

women’s concern about their children was genuine rather than deceptive or deluded.

Despite interviewing a total of 124 inmate-mothers about the health and welfare of their

children, their experiences with state agencies, and the arrangements they made for their

children upon being imprisoned, the report chalked up women’s varied answers to denial.

The prison code of condoning women’s maternal concerns resulted in “conscious or

unconscious distortions by inmate-mothers as to the adequacy of the care they gave their

299 Ibid, p. 4-6. 300 Ibid, 3. 301 Though the report was also sure to attribute “involvement in homosexual relationships” to women’s attempts to “deny or evade anxieties or concerns or responsibilities related to their roles as mothers,” Ibid, p. 12. 302 Ibid, p. 12, 60.

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children before they were incarcerated, and the inadequacy of the children’s care

currently provided by others.”303 So great was this distortion that inmates who articulated

plans to reunite with their children upon parole release were explained away as

manipulative, motivated by “what would gain institutional approval and the earliest

parole date.”304

Women’s expressions of concern gathered through interviews were overshadowed

by demographic data that created a typical profile of mothers at CIW. Despite the fact

that more than half of the inmates in the study had an average of 2.4 children, only a third

of them were currently married. Researchers found that two-thirds of the inmates had

been victims of economic deprivation or family emotional problems when they were

children, which was used to explain their high proportion of marriage at young ages,

subsequent divorces, and criminal involvement as adults. 77 percent of inmate-mothers

had histories of deviant behavior including drug use, alcoholism, prostitution,

homosexuality, institutionalization, and suicidal ideation. Prior to incarceration, 62

percent of mothers had left their children to be cared for by others.305

Given this profile, researchers were most interested in how to facilitate inter-

agency cooperation that would protect against the inmate-mother’s ability to “sabotage

otherwise sound and realistic plans for child care.”306 If a prisoners’ case-manager was

unaware of her parole plans, then so too was the child welfare worker ostensibly handling

the welfare of the women’s child. This left agency workers and the children of

incarcerated women vulnerable to “questionable removal of children from households

303 Ibid, 60. 304 Ibid, 79. 305 Ibid, 27-54. 306 Ibid, 120.

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they had come to know as home.” In addition to the harm caused to the child, this

“precipitous movement of children” could also “detract from the mother’s potential for

parole success.” Instead, women who “could not let go of their children,” needed

additional support during their incarceration to aid in resolving “the feelings of the

inmate-mother regarding separation from her children in the future.”307

In other words, “inmate-mothers”—along with drug addicts, lesbians, and

prostitutes—were not really fit to be mothers at all, and any expression of concern for

their children was the result of the “institutional culture” in prison that gave motherhood

a privileged status. Yet, if incarcerated mothers were unfit for motherhood in the eyes of

child welfare researchers in 1964, less than a decade later their study was being used to

argue for the urgent need to rectify incarcerated women’s “uniquely female deprivation.”

A 1973 law article outlining the problems in underserved, under resourced correctional

facilities for women referenced Zalba in its discussion of the inaccessibility of women’s

institutions. “While male parents are also parents, society does not place upon the father

the responsibility for minute details of daily care as it does upon the mother. Zalba, in a

1964 study of women prisoners and their families in California, expressed the view that

“The role of the mother is more crucial for the mother herself than is the father’s role to

him.” The fact that the majority of women prisoners were also mothers combined with

the lack of infrastructure to aid regular visitation exacerbated the challenges that awaited

women upon leaving prison—“her task of daily child care and discipline.”308

This early article was only the beginning. The research from the 1960s that had

depicted women as dependent, deluded, unfit lesbian mothers continued to shape the

307 Ibid, 117. 308 Gibson, 1973, p. 224-225.

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maternal profile of the female offender in the 1970s. A special 1974 issue on Planning for

the Female Offender from the American Association of Correctional Psychologists

referenced Ward and Kassebaum and Giallombardo’s respective studies as evidence that

“lack of family ties is a critical deprivation experience for women in prison” to bolster

the proposal that “institutions be near the woman’s home community.”309 An article on

the parental rights of women referenced Zalba’s study to prove that “female offenders

who are mothers face a two-pronged sentence. First they must serve the prison term, and

second, they must cope with the additional punishment of a temporary or permanent

deprivation of parental rights.”310 Another article referenced the study to demonstrate the

psychological trauma accompanying involuntary separation of mother and child.311 And

again, in a 1979 article assessing the correctional response to the female offender, the

same studies helped bolster the claim that “deprivation from family and social structures

is more keenly felt by women prisoners than men,” and as a result the “worst problem of

prison mothers and their children is enforced separation.”312

While the citational life of Ward, Kassebaum, Giallombardo and Zalba was

limited to research articles, the exceptional deprivation of imprisoned mothers’ which

they helped establish continued to be foregrounded by advocates concerned with the

female offender. Those working in New York City to help women with their legal claims

informed correctional officials that women’s social and legal relationships to their

309 Annette M. Brodsky, “Planning for the Female Offender: Directions for the Future,” Criminal Justice and Behavior, 4(1) December 1974, 392-400, p. 395. 310 Kathleen Haley, “Mothers Behind Bars: A Look at the Parental Rights of Incarcerated Women,” New England Journal on Prison Law, 4(141), 1977-1978, p. 141-155, p. 142. 311 Avery Eli Okin, “Inmates Rights to Motherhood,” Brooklyn Barrister, n.d., Friends Committee on Legislation of California Records, FCL Series Prisons, Box 2, Folder “Prison Nursery,” California State University, Sacramento. 312 Sharon L. Fabian, “Toward the Best Interests of Woman Prisoners: Is the System Working?,” New England Journal on Prison Law, 6(1), Fall 1979, 1-60, p. 21, 24.

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children was the number one problem unique to female offenders. “Many children of

women prisoners are either placed in foster care, unsuccessfully put up for adoption, or

are never returned to their natural mothers even in most cases where that would be

beneficial to them.”313 Similarly, legal advocates representing women incarcerated in jails

and prisons in California testified before the Assembly Select Committee on Corrections

that “the most cruel way in which most women in prison and jail are treated is that they

are torn from their children and their families.”314 The Chicago branch of the AFSC

informed members that “women’s prisons are hotbeds of horror stories of mothers who

don’t know where their children are” and reported that 80 percent of inmates at Cook

County Women’s Correctional Facility were also mothers.315 Publications for women in

prison and their supporters, such as No More Cages, also reported on the “cruel and

damaging” process of women’s separation from their children.”316

Given the field of possibility available to advocates, one in which women in

prison were rarely the concern of criminal justice and governmental officials, it makes

sense that formal and anecdotal reports tried to emphasize their point about imprisoned

mothers by framing it as the greatest single concern articulated by women in prison.317

313 Letter to Ken Carpenter from Marilyn G. Haft, Barbara Swartz, Polly Feingold, Jan 7, 1974, p. 1, ACLU Prison Project Papers, Box 2999, Folder “Women in Prison,” Mudd Library, Princeton University. 314 “Testimony Before the Assembly Select Committee on Corrections,” presented by Claudia Bernard and Laurie Hauer of the Women’s Litigation Unit of San Francisco Neighborhood Legal Assistance Foundation, September 28, 1977, Private Collection of Ellen Barry. 315 American Friends Service Committee Newsletter MidWest Branch, 1976, Friends Committee on Legislation of California Records, FCL Series Prisons, Box 2, Folder “Women in Prison,” California State University, Sacramento. 316 “Mothers in Prison and Their Children: Breaking Down the Walls,” No More Cages: A Bi-monthly Women’s Prison Newsletter, Vol. 2, No. 3, December 1980, p. 21, Nancy Stoller Papers, Folder “No More Cages,” UCSF Library. 317 As evidenced by the way the studies from the 1960s took on an entirely new meaning in the hands of advocates, it is incredibly difficult to confirm the accuracy of advocates’ claims. To be sure, many were basing their assertions about maternal suffering on their work in women’s prisons and what they heard from inmates. But advocates working on other issues facing women prisoners also claimed to have

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The dearth of sound research on incarcerated women made this framing all the more

compelling. The reality, of course, was that the issues confronting women in prison were

intersectional and compounding and that economic survival and the well-being of their

children were most likely of equal concern to women, as were legal issues related to their

convictions, education, and housing upon release.318 Such challenges also varied

depending on which phase of criminalization women were in. Yet, given the difficulty in

convincing criminal justice officials of women’s rehabilitative needs, advocates may

have felt the need to elevate one challenge above the rest.

The emotional component of maternal incarceration aided its elevation, and it did

not take long for the concern about the mothers in prison to evolve into an argument for

the rehabilitative potential of motherhood. What had been a destructive (and self-

deluded) force in the lives of women and their children for Zalba in the 1960s became a

powerful argument for gender-specific initiatives aimed at preserving motherhood in the

1970s. More than one article published during this period called for the development of

programs that would allow women to keep their children with them in penal institutions,

particularly during the earliest stages of childhood.319 Such programs would make it

identified the number one grievance articulated by incarcerated women. For example, The Female Offender Resource Center and the Women’s Bureau in the U.S. Department of Labor foregrounded lack of employment as the number one concern expressed by offenders. 318 For example, a study conducted in 1974 looking at post-release programs for women offenders in D.C. identified education, employment, and family ties as the most important factors in rehabilitation. Irene Mields, “Pre-Trial Intervention Programs and Related Services for Women in Washington, D.C.,” May 6, 1974. Cited in “Community Programs for Women Offenders: Cost and Economic Considerations,” Correctional Economics Center, American Bar Association, June, 1975, p. 6. 319 Richard Palmer, “The Prisoner Mother and Her Child,” Capital University Law Review, Vol. 1, 1972, p. 127-144; Kathleen Haley, “Mothers Behind Bars: A Look at the Parental Rights of Incarcerated Women,” New England Journal on Prison Law, 4(141), 1977-1978, p. 141-155; Hoffman SL, “On Prisoners and Parenting: Preserving the Tie That Binds,” Yale Law Journal, 87(7), June 1978, p. 1408-1429, p. 1423-1424; Sharon L. Fabian, “Toward the Best Interests of Woman Prisoners: Is the System Working?,” New England Journal on Prison Law, 6(1), Fall 1979, 1-60, p. 58.

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“possible to construct a truly rehabilitative atmosphere for incarcerated mothers,”

according to these supporters.320 Some of these authors even advocated for special

programs called “mother-release.”321 Modeled after work-release programs aimed at

helping prisoners line up jobs prior to parole, a “mother-release” program would allow

“the prisoner-mother…to use her work-release time for the achievement of her post

incarceration duties, performing her parental responsibilities…and thus satisfy the child’s

best interests as well as aid in her own rehabilitation.”322 The Women in Prison

chairperson for a NOW California chapter also endorsed what she called “infant care

furloughs” that would release “the new mother and baby to her home community and her

other children.”323 A program for mothers and their children at the Purdy Treatment

Center for Women in Washington was cited as a potential national model by those in

support of specialized programs for mothers in prison. The superintendent at Purdy

explained the importance of rehabilitation for women in prison. “We believe that

mothering is an extremely important role for women with children in our society, and,

therefore, should be a vital part of any total rehabilitative program for women. Children

320 Haley, p. 154. 321 Palmer develops the idea of “mother-release” most in depth, but Haley also suggests that work-release could be extended to “provide a means for the mother to be released in order to perform her parental duties,” Haley, p. 154. 322 Palmer, p. 141-142. Palmer also argued for increased visitation that allowed privacy and physical contact for mother and child on the grounds that it had a rehabilitative promise. “It is submitted that extending the visitation privileges of the prisoner-mother to this extent would be a valuable aid to her rehabilitation, in that it would provide a type of family association which would otherwise be absent during her confinement. It is the duty of the legislatures to provide means for the prisoner-mother’s rehabilitation. This program is such a means and should be implemented into the present programs that have been established by the legislatures,” p. 143. 323 Kay Nollenberger, “Jail Babies: Punishment of the Inncocent,” n.d., Friends Committee on Legislation of California Records, FCL Series Prisons, Box 2, Folder “Women in Prison,” California State University, Sacramento.

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may visit any day of the week during daylight hours. Their only supervision comes from

their mother.”324

For advocates then, the question was not if women should be reunited with their

children, but how to go about making corrections acknowledge women’s maternal pain

and responsibilities. While those in favor of mitigating the maternal-child separation

sometimes differed on how solutions should be implemented, all agreed that

reestablishing a woman’s maternal role must be the most important aspect of

rehabilitation for incarcerated women. Yet behind this shared goal was a mixed bag of

motives and investments. Specifically, advocates seemed unable to untangle incarcerated

women’s right to motherhood from paternalistic beliefs about both women’s roles as

mothers and the supposed dysfunction of families afflicted by poverty, incarceration, and

substance abuse. The tendency to attribute blame to women’s failure as mothers rather

than the societal forces so salient in other discussions of female criminality was also

present in those who worked directly with incarcerated women. For example, in the same

breath that the director of THE PROGRAM in Pittsburgh advocated for mothers and

children to live together in a non-institutional setting, Charolette Ginsburg also

emphasized the brokenness of prisoners’ own families and the need for them to “learn to

be good parents.”325 Similarly, the superintendent at the Purdy Treatment Center declared

that “visits” of “up to eight hours are encouraged so that planning, discipline, and other

324 “Keeping Mother and Child Together,” An Overview, Vol., 2, No. 9, Department of Health and Human Services Olympia, Washington, September, 1974, Friends Committee on Legislation of California Records, FCL Series Prisons, Box 2, Folder “Assembly Bill 512: Retention of Children by Mother in Prison,” California State University, Sacramento. 325 “Who Are the Women in Prison?” p. 55, Charlotte Ginsburg in Women in Corrections, Ed. by Barbara Hadley Olsson, American Correctional Association, 1981.

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mothering skills are exercised or developed in addition to the pleasure of visiting.”326 The

idea that women in prison not only needed to learn how to be good parents but also

needed to understand that motherhood was a responsibility motivated those who fought to

expand what were also ultimately female prisoners’ rights.

While these subtle appeals to women’s broken familial ties were certainly coded

invocations of poverty and race, by and large discussions of motherhood’s rehabilitative

potential were strikingly silent on the racial demographics of the “mother-prisoner.”

Articles and appeals in favor of motherhood as rehabilitation emphasized women as

mothers, undifferentiated by race and class, marked instead only by their criminal status.

Sometimes poverty and education level entered discussions of women’s role as the

primary caretakers of dependents, as some advocates emphasized the need for viable

employment upon release if women were to be able to provide for their children. Yet the

majority proffered suggestions of “mother-release” programs and “community treatment

centers” free of context, and as a result such recommendations tended to invoke images

of idealized middle-class domesticity. “Mother-prisoners” were imagined as white, and

“mother-release” was feasible because prisoners were married to a man who was also the

primary wage earner. Even as advocates constructed the “female offender” as antithetical

to the white, educated, middle-class women’s libber, in discussions of motherhood they

managed to paint the “prisoner-mother” as lacking all characteristics beyond her maternal

status, and, as a result, she implicitly took on society’s “default” characteristics,

becoming white and even married. It is hard to determine from sources if this was

326 “Keeping Mother and Child Together,” An Overview, Vol., 2, No. 9, Department of Health and Human Services Olympia, Washington, September, 1974, Friends Committee on Legislation of California Records, FCL Series Prisons, Box 2, Folder “Assembly Bill 512: Retention of Children by Mother in Prison,” California State University, Sacramento.

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tactical or reveals advocates’ own ideas about motherhood. Yet, in this limited way,

advocates attempted to make mothers in prison the source of sympathy rather than

derision by foregrounding their “uniquely gendered deprivation.” 327 These initial appeals

to rehabilitation would be taken up by advocates during the late 1970s and 1980s in order

to win reforms for mothers in prison.

Mothering From Behind Bars in the Golden State

The discursive space created by advocates arguing for the rehabilitative effects of

motherhood was one thing; making prisons and jails accommodate the reproductive labor

of parenting was another thing entirely. Most often framed as making the correctional

institute “child-friendly” or “suitable for children,” demands brought by mothers in

prison required corrections to make the reproductive labor of caretaking a viable

endeavor within the confines of the prison. This alteration to the structure of incarceration

would prove difficult to permanently institutionalize, particularly as women began to feel

the effects of a prison system strained by the ever increasing problem of overcrowding

fueled by “tough on crime” sentencing legislation. The accommodations won by

incarcerated women with children were piecemeal and precarious at best, with

corrections’ embrace of maternal incarceration largely a rhetorical strategy rather than an

institutional response to the crisis of mass incarceration.

By and large, prisoners and advocates pursued two strategies for forcing

corrections to acknowledge the familial lives of prisoners. The first involved appealing to

outdated state laws that allowed incarcerated women to keep their children with them 327 It is worth noting that the period of an uncritical embrace of the prisoner as mother was somewhat short lived, as the framing turned to the children by the early 80s. This really happens with Blumenthal’s study, and is a potential direction to explore in future drafts.

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upon imprisonment. This strategy was limited to states that had developed legislation to

accompany the prison nurseries included in some women’s reformatories. While the

majority of prison nurseries were no longer active, the legal right to keep one’s child

while serving out a sentence remained enshrined in state law. Women in a handful of

states made use of these laws and were often successful for the brief window before most

state legislatures voted to repeal this right.

The second strategy was driven more by the framework of rehabilitation, at least

initially. This strategy involved creating programs that facilitated sustaining the mother-

child bond over the course of one’s imprisonment. Things like children’s centers,

programs that aided families with transportation to correctional sites, and parenting

classes were incorporated into the system of corrections with varying degrees of

permanence, collaboration between outside organizations and prison officials, and inmate

leadership. This strategy was especially dependent on the good will of prison officials

and community support. As such, it was most vulnerable to charges that it created a

veneer of rehabilitative reform while lacking adequate structures of support underneath.

California, which employed both strategies, was somewhat exceptional in the

robust reforms it managed to implement. Given California’s reputation as a pioneer of

rehabilitation programs, it is not surprising that efforts to institutionalize supports for

incarcerated women went the furthest in this state, or that battles to maintain their

existence were particularly prolonged and hostile in light of California’s growing

enthusiasm for harsh sentencing laws and prison construction. California is also a good

place to examine the emergence of efforts to support mothers in prison at the federal

level. Advocacy on behalf of prisoners and their children that began in the San Francisco

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Bay Area constituted the origin point of the Bureau of Prison’s (BOP) confrontation with

prisoners’ reproductive lives.

While some advocates committed to prisoners’ parental rights felt that the

solution to mother-child separation lay less in trying to make prison fit for expectant

mothers than in “finding alternatives to sending pregnant women there in the first place,”

numerous lawsuits brought against correctional facilities throughout the mid-1970s and

early 1980s revealed that prisoners did not necessarily agree.328 Incarcerated women,

many of whom were pregnant at the time of their imprisonment, began to make use of

state statutes that recognized an imprisoned woman’s right to keep her child with her in

the correctional institute up to a certain age. Only a handful of states had such statutes on

the books, but those that did—save New York—were not actively implementing this

option within women’s correctional facilities.329

California was one of these states. A 1929 statute that allowed women to keep

their children with them in correctional institutes existed in policy rather than practice.

Barbara Cardell was pregnant upon her imprisonment at CIW, Frontera in the mid-1970s.

She had to sue prison officials in order to receive appropriate accommodations for her

newborn. In 1976, Cardell, three other prisoners at CIW, and the Bay Area-based prison

advocacy group Women’s Prison Coalition filed an administrative petition against the

California Department of Corrections for refusing to acknowledge the 1929 law.330 In it

they argued that the statute “created an absolute right in the mother to keep her baby with

328 Austin Gerald McHugh, “Protection of the Rights of Pregnant Women in Prisons and Detention Facilities,” New England Journal on Prison Law, Vol. 6, 1980, p. 262-263, p. 231-263. 329 The prison nursery at Bedford Hills Correctional Facility for Women is the most often invoked example of a successful program for mothers and their children. It is also one of the most studied. Whereas states with statutes pertaining to prisoner mothers’ rights may have once run prison nurseries, Bedford Hills is the longest running prison nursery in the country. 330 “Unconstitutional to Take Infants From Incarcerated Mothers,” The Sun Reporter, November, 11 1976.

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her while she is incarcerated.”331 The court found that because the statute provided the

mother the option to keep her child but did not mandate that she do so, correctional

officials actually had ultimate discretion.332

Those in support of Cardell and the other women at CIW appealed to a number of

frameworks in an attempt to convince the state of their position. A staff attorney for the

Women’s Litigation Unit of the San Francisco Neighborhood Legal Assistance

Foundation explained to the California Legislature Assembly Select Committee on

Corrections, “There are at least eight different ways in which a child may be taken from a

natural parent. The complexity of these methods baffles the minds of the law review and

treatise editors, and does havoc to the individual unschooled in custody proceedings.”333

At the same time, they appealed to the research on rehabilitation and motherhood,

arguing “the recidivism rate for women who keep their children with them is

phenomenally low,” and asserted that “the cruel irony of the present situation is that the

state, ostensibly committed to the eventual social reintegration of inmates, denies

prisoners the opportunity of preserving those relationships which have been shown to

contribute substantially to her successful reentry into society.”334 Ultimately, these

arguments bolstered advocates’ framing of motherhood as a fundamental right. “We urge

this Committee to take all possible steps to ensure that prison mothers’ rights to their

331 Terri L. Schupak, “Women and Children First: An Examination of the Unique Needs of Women in Prison,” Golden Gate University Law Review, Vol. 16, No. 3, 1986, p. 455-474, p. 471 332 Ibid, p. 471. 333 “Testimony Before the Assembly Select Committee on Corrections,” presented by Claudia Bernard and Laurie Hauer of the Women’s Litigation Unit of San Francisco Neighborhood Legal Assistance Foundation, September 28, 1977, Private Collection of Ellen Barry. 334 “Unconstitutional to Take Infants From Incarcerated Mothers,” The Sun Reporter, November, 11 1976; “Prisoners’ Rights to Personal Presence at Divorce and Family Court Hearings,” n.d., Submitted by The Women’s Litigation Unit of San Francisco Neighborhood Legal Assistance Foundation, Private Collection of Ellen Barry, p. 4.

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children are not taken away, whether by deliberate intention or by prison personnel

inattention. Women in prison must be given the opportunity of keeping their families

united.”335

The Women’s Prison Coalition was not the only group invested in the idea of an

alternative program for incarcerated women with children, nor were lawsuits the only

tactic implemented in an attempt to strengthen the existing statute. The Quaker legislative

group Friends Committee on Legislation of California (FCL) was also pressuring

legislators in hopes of amending the statute through Assembly Bill (AB) 512. State

Assemblyman Terry Goggin introduced the bill in February of 1977, joined by other

legislators, some of whom had become interested as a result of the courts’ decision in the

Cardell case.336 AB 512 aimed to ensure state prison officials could not undermine

women’s right to the statute and to require the CDC to provide adequate

accommodations. Specifically, the bill mandated the development of a community

treatment program for mothers and their children to be administered by community

agencies contracted by the CDC.

In order to mobilize political support for the bill, Goggin’s office took an

altogether different approach from those who saw motherhood as rehabilitative or as a

335 “Testimony Before the Assembly Select Committee on Corrections,” presented by Claudia Bernard and Laurie Hauer of the Women’s Litigation Unit of San Francisco Neighborhood Legal Assistance Foundation, September 28, 1977, Private Collection of Ellen Barry. 336 Assembly Bill 512, February 14, 1977, California State Legislature, Friends Committee on Legislation of California Records, FCL Series Prisons, Box 2, Folder “Assembly Bill 512: Retention of Children by Mother in Prison,” California State University, Sacramento. Assemblywoman Leona H. Egeland who co-sponsored the bill wrote to an analyst at the Legislative Council of California in 1976 inquiring about the ability of the CDC to refuse a mother’s request to keep her child with her during imprisonment. The reply clearly states that the existing statute not only permits state prison officials to refuse a mother’s request, but to also make arrangements for the child—including custody—without her consent. Letter to Leona H. Egeland from George H. Murphy, January 19, 1976, Friends Committee on Legislation of California Records, FCL Series Prisons, Box 2, Folder “Assembly Bill 512: Retention of Children by Mother in Prison,” California State University, Sacramento.

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right. AB 512 opened, “The Legislature finds that the separation of infants from their

mothers, while their mothers are in prison, can cause serious psychological damage to

such infants.”337 In the press release announcing the bill, Goggin echoed the language of

the legislation, citing research that warned of the “serious psychological damage children

suffer when they are deprived of a constant source of nurturing during their first two

years of life.” Whereas advocates writing about and discussing mother-child programs

attempted to rescue the criminal mother by foregrounding the rehabilitative power of

mothering, when it came to getting support for prison reform legislation in California,

Goggin decentered women, foregrounding children in their place. 338 “We should not

punish the babies along with their mothers who have committed crimes. My bill will

require the Department of Corrections to minimize the tragedies of separating infants

from their mothers.”339 FCL members followed suit. In a letter urging another senator to

vote yes on AB 512, FCL legislative aide Ruth Flower explained, “The experience of a

prison sentence is often as devastating to the family of a prisoner as it is for the prisoner

himself or herself. Family contact in a warm, home-like environment may well be crucial

to the development of a child into a self-reliant adult.”340

337 Assembly Bill 512, February 14, 1977, California State Legislature, Friends Committee on Legislation of California Records, FCL Series Prisons, Box 2, Folder “Assembly Bill 512: Retention of Children by Mother in Prison,” California State University, Sacramento. 338 While there is not explicit discussion of this tactic in the sources, the opening line citing the psychological damage to infants was not added as an amendment to the bill until January 3, 1978, a year after its initial proposal. See “Author’s Amendments to AB 512, As Amended January 3, 1978,” Friends Committee on Legislation of California Records, FCL Series Prisons, Box 2, Folder “Women in Prison: Articles and Newsletters,” California State University, Sacramento. 339 “News from the Office of Assemblyman Terry Goggin,” February 14, 1977, Friends Committee on Legislation of California Records, FCL Series Prisons, Box 2, Folder “Women in Prison,” California State University, Sacramento. 340 Letter to Senator Alfred Song from Ruth Flower, February 13, 1978, Friends Committee on Legislation of California Records, FCL Series Prisons, Box 2, Folder “Women in Prison,” California State University, Sacramento.

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In order to fully understand this framing, it is necessary to account for the broader

shifts occurring around crime and punishment in California during this period. The same

year Goggin introduced AB 512, the California Legislature passed SB 42, the Uniform

Determinate Sentencing Act (UDSA), bringing the state’s sixty-year dependence on

indeterminate sentencing to an end.341 Echoing the sentiment of prisoner activists,

prisoner rights advocates, and expert criminologists calling for the abandonment of

rehabilitation, SB 42 stated, “The Legislature finds and declares that the purpose of

imprisonment for crime is punishment. This purpose is best served by terms

proportionate to the seriousness of the offense with provision for uniformity in the

sentences of offenders committing the same offense under similar circumstances.” On

this, diverse interest groups working on criminal justice reform in California could agree.

“SB 42’s rejection of the rehabilitation model for a punitive one was almost a consensus

position, with law enforcement on the one hand, and the ACLU, Prisoners Union, Friends

Committee, and criminal defense attorneys on the other, generally concurring that the

grand experiment of rehabilitation had not worked,” wrote a legislative representative for

ACLU of Northern California 342

Yet, the consensus on rehabilitation’s “grand” failure quickly unraveled, as it

became clear that radically opposed investments in criminal justice reform were lingering

just below the shared opinion on rehabilitation. In keeping with the authors of major

reports calling for an end to rehabilitation, prisoners’ rights groups in California were

341 “New Fixed Sentencing Takes Effect Today Statewide, Recorder, July 1, 1977, Friends Committee on Legislation of California Records, FCL Series Criminal Justice, Box 5, Folder “Senate Bill Implementation 1976-1977,” California State University, Sacramento. 342 “Both Sides Now,” Brent A. Barnhart, Legislative Representative ACLU of Northern California, October 18, 1976, Friends Committee on Legislation of California Records, FCL Series Criminal Justice, Box 5, Folder “Senate Bill 42: Proposed Sentencing Law 1975-1976,” California State University, Sacramento.

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eager to support determinate sentencing legislation, but only on the condition that shorter

sentences and more robust alternatives to incarceration were a major component of the

“new” wave of criminal justice.343 Instead, groups like FCL and the Prisoners Union

watched as the bill became a litmus test for then Governor Edmund Brown and other

officials to prove their commitment to being tough on crime, a position that left little

room for considering the effects of imprisonment on society at large or prisoners

themselves. Law enforcement spokespersons such as Los Angeles Police Chief Ed Davis

stoked public fears about personal safety, saying that SB 42 would trigger the release of

thousands of dangerous criminals from prison. So powerful was this move that one of the

many amendments made to the legislation extended confinement for dangerous prisoners

despite the fact that there were already provisions excluding certain classes of criminals

from benefitting from the new sentencing guidelines.344 A coalition of nine prisoners’

rights groups organized a press conference at the state’s capitol a year after the bill’s

introduction to go public with their concerns “about the legislative negotiations” on SB

42 and two other bills aiming to classify sixteen- and seventeen-year-olds as adult

offenders. They directed their ire at Governor Edmund Brown for giving “carte blanche

powers to law enforcement representatives (the district attorneys and police) to draft any

provisions they feel are appropriate. Where it was once possible to negotiate with all

sides on these important problems, we now find that as long as law enforcement has the

343 For example, the Coordinating Council of Prisoner Organizations worked on amendments to the legislation in 1975. See “Proposed Amendments to SB 42, draft,” May 22, 1975, Friends Committee on Legislation of California Records, FCL Series Criminal Justice, Box 5, Folder “Senate Bill 42: Proposed Sentencing Law 1975-1976,” California State University, Sacramento. 344 See “Struggling with SB 42,” FCL Newsletter, Vol. 26, No. 1, January 1977, Friends Committee on Legislation of California Records, FCL Series Criminal Justice, Box 5, Folder “Senate Bill 42 Implementation 1977,” California State University, Sacramento.

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governor’s proxy there is no room for viable change. We have no choice but to oppose

SB 42 and the juvenile bills.”345

Almost immediately, the drive for harsher sentences produced effects unaddressed

by tough on crime rhetoric. Just two years after California voted for determinate

sentencing, the director of the CDC penned an editorial in the Los Angeles Times making

an urgent plea for new prisons in order to ease overcrowding. Responding to an editorial

written by a member of the Unitarian Church coming out against funding proposals being

considered by the legislature, Jerry Enomoto countered “The prison population increased

2,000 last year, and another 800 in the first four months of 1979. California has not built

a new cell-type prison since 1961. We will be forced to undertake a wide range of crisis-

induced alternative programs, in addition to extensive and unprecedented double-celling.

Even if these and other emergency moves are successful beyond current expectation, they

will not eliminate the urgent need for new prisons.”346 By 1981, the CDC was calling for

the construction of more than six new prisons over the next ten years in order to keep

pace with the projected growth of incarcerated persons.

In this climate, then, it is hardly surprising that an appeal to innocent children was

more politically expedient than claims to rehabilitation or prisoners’ rights. What is

surprising is that AB 512 passed in a political climate already incredibly hostile to

programs for prisoners. In their study of women’s crime and imprisonment in California

since 1960, Candace Kruttschnitt and Rosemary Gartner argue that the enactment of

determinate sentencing in 1977 signaled a “formal and explicit” rejection of

345 The nine groups included: ACLU of Southern and Northern CA, FCL, AFSC, Committee for Prisoner Humanity and Justice, Community Alternatives to Prison, Prisoner’s Health Project, Project Forum West, National Council on Crime and Delinquency, and the Unitarian Universalist Service Committee. “Press Conference—Brown Criticized for Criminal Justice Stance,” May 25, 1976, 346 J.J. Enomoto, “California’s Need for New Prisons,” Los Angeles Times, May 26, 1979.

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“rehabilitation as an objective of imprisonment in California.”347 But what does this

signpost really tell us about women incarcerated by the CDC, particularly in light of the

passage of AB 512? Prior to the enactment of both statutes, incarcerated women in

California hardly benefited from the supposed rehabilitative phase of incarceration

despite the fact that the state was recognized as a national leader in innovative and

progressive rehabilitation programming. A 1970 report examining the effects of

vocational training on women’s parole performance found that nearly all of the training

options replicated the unskilled and semi-skilled labor capacities that inmates brought

with them to CIW. The one program that did have a 100 percent success rate was

cancelled after only a year of operation due to “administrative problems.”348 Five years

later, minutes from an early Women’s Prison Coalition Meeting indicated that

institutional support for women at CIW had only lessened. Budget cuts that year had

forced the director of Vocational Training to suspend all work programs for women.349

Given this, we can read AB 512 as a significant achievement for incarcerated

women and their advocates, one that put women prisoners on the map in a way that prior

organizing around equal rights to work furlough programs had not. Its passage meant the

California legislature had approved an alternative-to-incarceration program in spite of

347 Candace Kruttschnitt and Rosemary Gartner, Marking Time in the Golden State: Women’s Imprisonment in California, Cambridge University Press, 2005, p. 15. 348 The report stated “it is obvious that the selection of the courses in the vocational training program at CIW was based on their practical contribution to the ongoing operation of the institution rather than an assessment of needs of either the labor market or the potential employee.” Carol Spencer, John E. Berecochea, “Vocational Training at the California Institution for Women: An Evaluation,” Research Report No. 41, Research Division, California Department of Corrections, p. 30-33, Friends Committee on Legislation of California Records, FCL Series Prisons, Box 2, Folder “Vocational Training in Women’s Prisons,” Sacramento State University Library. 349 Women’s Prison Coalition Meeting Minutes, October 21, 1975, Private Collection of Ellen Barry. The situation at county jails was even worse, and much of the efforts of the Women’s Prison Coalition went towards forcing San Francisco County to create a work furlough program for women sentenced to San Bruno Jail, efforts that were largely unsuccessful.

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immense hostility towards prisoner-centered reform on the one hand and a

disillusionment with rehabilitation on the other. And yet it also evidences the limitations

that defined prison reform in the name of the “female offender.” Even the maternal

suffering highlighted by advocates was absent from AB 512. In the formulation of the

bill, motherhood was powerful enough to counteract negative ideas about women in

prison, but only for the sake of children who society hoped might “break the cycle” of

criminality with the love of their mothers. Symbolically, the “female offender” in

California needed to serve an instrumental purpose in order to garner legislative action.

She also needed to steer clear of taxpayers’ pockets. AB 512 required no

legislative appropriation but instead mandated CDC officials to allocate funds from the

existing budget in order to implement the program. Whatever additional funds the

program might require, the CDC would have to raise on its own; the bill even made sure

to cap the amount that could be drawn from the General Fund. Bombarded with major

changes ushered in by the new sentencing legislation and feeling the pressure of

numerous facilities reaching capacity, CDC officials were mandated to create a new

program for their smallest population and provided no additional funds or personnel with

which to do so. Unsurprisingly, less than a year after AB 512 had passed, community

groups tracking the bill’s progress were concerned. The Committee for Women and

Children of the East Long Beach Neighborhood Center informed members “little has

been done to implement this legislation. In placing numerous calls to drug, probation and

correction institutes, little or no information was available concerning the progress of

such facilities.” Based on their research, the Committee concluded that the CDC “is

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impeding and disregarding the rights of inmates to have access to an alternative

community mother/child rearing program.”350

The recently formed community-based AB 512 Task Force agreed. In a letter to

the CDC official in charge of submitting an implementation report, the Task Force listed

numerous problems with the CDC’s movement forward on the program. While the

program was set to start in January of 1980, by April of that same year there still were no

contracts with community agencies in place, prisoners had not been informed of the

program, no official protocol had been developed, and no additional funds had been

raised.351 The task force also expressed concern about the language of the bill that FCL

members had tried to avoid four years prior. In addition to finding the child’s age limit of

two years arbitrary and overly restrictive, the task force returned once again to the

“fitness” issue, arguing that applying to participate in the program should not trigger

filing for a fitness proceeding if the woman had a history of addiction. Such a

requirement not only disproportionately impacted drug-users, but also put women at risk

of losing their parental rights, a far greater risk than not being able to participate in the

program.

A successful amendment to the bill increased the age of eligible children from

two to six, making the Mother-Infant Care Program the most inclusive of its kind in the

country. But the complaints regarding the program’s implementation persisted, ultimately

bringing about a five-year long lawsuit. When the suit was filed in 1985, only three

350 Letter to Department of Corrections from Committee for Women and Children, “Program Development for Community Child Care Alternative,” October 1, 1979, Friends Committee on Legislation of California Records, FCL Series Prisons, Box 2, Folder “Women in Prison: Articles and Newsletters,” California State University, Sacramento. 351 Letter to Tony Antonuccio, CDC from A.B. 512 Task Force, “Implementation of Assembly Bill 512,” April 7, 1980, p. 5, Friends Committee on Legislation of California Records, FCL Series Prisons, Box 2, Folder “Women in Prison: Articles and Newsletters,” California State University, Sacramento.

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women had been enrolled in a program that was legislated to be implemented five years

prior. Settled in 1990, the terms required that a number of changes be made to the

program, including appointing a statewide coordinator for the program and placing

childcare coordinators at each facility.352 A 2010 report by Legal Services for Prisoners

with Children (LSPC), one of the organizations that brought the suit in 1985, found that

the program was still operating below capacity, even as California’s three prisons for

women continued to bulge at the seams.353

Nearly 400 miles from CIW, Frontera, a federal prison in Pleasanton, California,

would become the site of yet another effort to bring the maternal needs of prisoners to the

forefront of correctional operations. As AB 512 and SB 42 were moving through the

legislature, a Children’s center was being developed at FCI Pleasanton, a first for the

federal prison system. Initiated by two Bay Area women who were new to prisoner

advocacy, Prison Mothers and Their Children (Prison Match) was distinct from the

statewide Mother-Infant Care Program in a number of ways. Rather than allowing federal

inmates at FCI Pleasanton to live with their young children, Prison MATCH began as a

robust visitation program intended to maintain relationships between incarcerated women

and their children. The Children’s center was created on the prison grounds as a space for

women to spend quality time with their children, and Center staff coordinated volunteers

to aid with transportation to and from the prison. The advocates who started Prison 352 Newsletter, National Network for Women in Prison, Vol. 1, No. 2, October 1990, p. 4-5, Friends Committee on Legislation of California Records, FCL Series Prisons, Box 2, Folder “Women in Prison,” California State University, Sacramento. 353 “California’s Mother-Infant Prison Programs: An Investigation,” Legal Services for Prisoners with Children, November 2010. There is much more to say about the more recent history of programs for mothers in California, particularly the creation of the Family Foundations Program which passed in 1994 and allowed drug addicted mothers to be sentenced to treatment facilities instead of prison. The LSPC report found that most of the women in FPP agencies were white, while most of the women in CPMP agencies were of color, reflecting the continued discretionary (and abuse of) power afforded judges despite determinate sentencing.

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MATCH brought with them experience in child development and community service

evaluation, respectively.354 As such, Prison Match’s stated aim was to “encourage the

correctional system to look at an incarcerated family as a total unit—needing meaningful

contact between parents and children during imprisonment and necessitating the

coordination of prison and community based resources for their needs.”355

Perhaps more significant than any other difference between the two programs was

the relative ease with which Prison MATCH became a part of FCI Pleasanton. After just

its second year of operation, staff reported, “the program has become much more

stabilized and widely accepted within the institution.” The number of children that visited

the center had increased from the prior year, as had inmate involvement. FCI staff also

appeared to have been won over. “I think you’ve gone from real suspicion—in almost

everyone—to folks saying, ‘This is a fantastic program. It is helping the mothers. It is

helping the kids.’” With the pilot year funded by foundation money, the program’s

success had also garnered BOP funds towards the running of the center and a new

vocational training program in Early Childhood Education also developed by Prison

MATCH staff. The BOP offered institutional as well as monetary support. Halfway

through the second year of operation, the BOP organized a national conference at FCI

Pleasanton with the aim of introducing the Prison MATCH model to other institutions.356

The collaboration between Prison MATCH and correctional officials documented in 354 Yvette Lehman was a professor of child development at Chabot Community College. Carolyn McCall was a recent PhD who had ties to the National Council on Crime Delinquency (NCCD). It was Yvette who wondered what happened to the children of incarcerated mothers, and Carolyn who had the project management background. Upon talking with women at FCI about programs that might be useful to them, they proposed their idea to the Warden. They also chose FCI rather than the state prison because they had heard FCI might be more amenable to such a program than CIW. Interview with Carolyn McCall, on file with author. 355 “The Pleasanton children’s center Program Second-Year Report and Evaluation, 1979-1980,” Feb 14, 1980, Prepared by Carolyn McCall, NCCD, Private Collections of Denise Johnston. 356 Ibid, p. 1-3.

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Prison MATCH records was worlds away from the frustrated letters and eventual lawsuit

that plagued CIW’s implementation of AB 512.

The fact that FCI Pleasanton was a federal facility also greatly influenced the

program’s success, particularly during its first years of operation. While California and a

number of other states passed legislation enacting lengthy sentences and even abolishing

parole in order to appear tough on crime during the late 1970s, it would take longer for

federal legislation to enact harsher punishments. As a result, the already urgent problem

of overcrowding that was plaguing some states had not reached the same tipping point in

federal institutions. Additionally, whereas state-level determinate sentencing laws were

made possible by the disillusionment with rehabilitation, the Bureau of Prisons seemed

less willing to give up this principle. While media outlets reported record numbers of

federal and state prisoners during the final years of the decade, those incarcerated at state

facilities made up the majority of the increase.357 By the end of 1978, the number of

prisoners at federal prisons had dropped seven percent from the year prior, thanks to an

increased reliance on halfway houses, parole, and shorter sentences. In contrast, that same

year, the number of prisoners at state prisons increased by four percent.358

Federal corrections’ comparative willingness to engage rehabilitation certainly

characterized the approach of the warden at FCI Pleasanton, whose visible and public

support of Prison MATCH was vital to the program’s success. Creating a children’s

center within the prison walls not only required access to the institution, but also

357 Specifically, five states were responsible for the record numbers, accounting for more than half the increase in state inmates (Texas, California, Florida, Michigan, and New York. See Gregory Gordon, “Record 307, 384 Inmates in State, Federal Prisons,” Atlanta Daily World, Jun 24, 1979. 358 Ibid. However, this reversal would be very short lived. In 1981, the three-year trend that reduced the federal prison population by 25% was reversed with the number of prisoners growing to 17% above federal facility capacity. See Michael J. Sniffen, “Prison Population Grew Record 12.1% in ’81, Study Says,” Boston Globe, May 3, 1982.

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cooperation from correctional staff. While there were some initial negotiations regarding

the scope of the program, the warden at FCI Pleasanton was thoroughly supportive once a

program design had been agreed upon.359 Warden Charles A. Turnbo authored numerous

letters of recommendation on behalf of the program as it pursued expansion. After the

first year of operation, he supported the program’s effort to offer a training component in

Child Development, writing “we certainly intended to give the program our continued

support and intend to recommend it to other institutions with female inmates.”360 To be

sure, at least some of his enthusiasm derived from a correctional perspective on tactics

for maintaining a strict environment, as evidenced by his pitch to other correctional

officers that the program had enhanced “discipline among the inmates.”361 Yet despite the

fact that his motivations diverged greatly from both advocates and inmates, the support of

an agreeable warden made all the difference in Prison Match’s successful beginnings.362

359 In one of the many grant proposals submitted by Carolyn McCall on behalf of Prison Match, she provided a brief history of the start of Prison Match. They had hoped for a daily program in which children and their mothers would spend each day together in pre-school like setting. This idea was “flatly rejected by the Warden,” whose counter offer was to organize special visits for children four times a year. Given this, the fact that they managed to agree upon full weekend visitation is noteworthy. See “Prison Match, A Research Proposal,” Submitted by The NCCD, February 22, 1980, p. 7, Private Collection of Denise Johnston. 360 Letter to Joan E. Duval from Charles Turnbo, November 16, 1978, Private Collection of Denise Johnston. 361 Letter to Charles Turnbo from Mark Kellar, November 16, 1981, Private Collection of Denise Johnston. 362 While it is somewhat obvious that without approval from officials an outside initiative will go nowhere no matter how innovative, my interviews with both Carolyn McCall and Katherine Gabel who co-founded Children of Incarcerated Parents made it clear that this was of utmost importance. They repeatedly stressed the necessity of an agreeable warden for the possibility of any outside collaboration to take root inside a facility. Interviews on file with author. This sentiment also shows up repeatedly in Prison Match’s grant material. In one particular proposal McCall writes, “Prison administrators control all programs inside in that access must be sought through them and then programs have to demonstrate that they are successful in order to stay.” See “Prison Match, A Research Proposal,” Submitted by The NCCD, February 22, 1980, p. 7, Private Collection of Denise Johnston. It is also emphasized in their materials meant to help other institutions start programs. “ You will never get ‘inside’ to plan unless you make a good contact with someone in the administration. A prison’s warden or superintendent has absolute control over entry to the prison and over any programming there,” “My Real Prison is Being Separated from My Children,” Janine Bertram, Carla Lowenberg, Carolyn McCall, Louise Rosenkrantz, 1982.

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Prison MATCH’s blend of child development expertise and prisoner advocacy

resulted in an approach that understood mother and child as a mutually dependent unit,

one that “formed out of a concern for the potential harm to both mother and child when

they are separated because of a mother’s imprisonment.”363 In a research proposal to

study the program in hopes of producing sound policy recommendations, it is clear that

staff understood themselves as continuing the scant research on maternal incarceration.

Once again, Zalba was re-purposed to serve the values of Prison MATCH staff who cited

the study as evidence that mothers wanted to resume their parental responsibilities upon

release but felt they did not have the adequate support to do so. For Prison MATCH, it

was important to understand the harm of incarceration as equally shared by mother and

child, but differentially experienced through maternal suffering and the threat of delayed

child development respectively. The program’s motto derived from a quote from a

mother incarcerated at the Minnesota Correctional Institution for Women, who had

declared, “My real prison is not being locked behind bars, my real prison is being

separated from my children.”364 At the same time, materials also echoed the sentiment

expressed in AB 512 when they depicted pictures of children beneath the heading “When

a mother is sent to prison, they are punished too.”365

Thus, the children’s center was meant to serve not only as a space where mothers

and children could “restore family ties,” but also as an opportunity to educate inmates

about the stages of child development and make them “experts” on their own parental

363 “Prison Match, A Research Proposal,” Submitted by The NCCD, February 22, 1980, p. 4, Private Collection of Denise Johnston. 364 Ibid, 37. The quote became the title of the Prison MATCHmanual that was distributed to other interested groups and correctional institutions. See “My Real Prison is Being Separated from My Children,” Janine Bertram, Carla Lowenberg, Carolyn McCall, Louise Rosenkrantz, 1982. 365 Prison Match/NCCD pamphlet, Private Collection of Denise Johnston.

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experiences. According to Prison MATCH reports, inmates had “argued for good

vocational training in the field of early childhood education” since the “program’s

inception,” as it was an opportunity to receive “training in an area which bears some

perceived relevancy to their lives.”366 Both inside and outside staff hoped that the

vocational program offering inmates a Child Development Associate’s Degree (CDA)

would enable them to work in federally funded children’s programs, such as Head Start,

upon their release. In a bid for funding from the Women’s Educational Equity Act

Program within the Department of Health, Education, and Welfare, Prison MATCH staff

turned the stigma of maternal incarceration on its head. “As any Head Start teacher

knows, some of such children are also the offspring of incarcerated parents. Women

inmates have stressed that they have as much or more of a right and responsibility to

work with these children as anyone in society because of their own unique life situations

and sensitivity to the issues involved in teaching public day care children.”367

In addition to framing the Prison MATCH program as a professionalizing

opportunity, the ethos of child development also affected interactions between mothers,

children, and staff at the Center. An evaluation report belies any trivializing notion that

the Center was merely an alternative, child-friendly visitation room. Rather, staff made a

deliberate effort to adapt “normative” child development models to the unique situation

of incarceration. “In the traditional children’s center, the focus of this age group is on

encouraging independence from the mother and the moving to peer contact and relations.

Our focus, on the other hand, has evolved as one in which we nurture needs as well as

366 “Prison Match, A Research Proposal,” Submitted by The NCCD, February 22, 1980, p. 15, Private Collection of Denise Johnston. 367 Child Development Associate Proposal submitted to HEW by Yvette Lehman, November 17, 1978, p. 14, Private Collection of Denise Johnston.

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enable the child to build or rebuild trust in their relationship.”368 Center staff also helped

small children make sense of the multiple primary caretakers in their life so as to

establish the mother’s central role in spite of her prolonged absence. For example, a

toddler named Michael was born in prison and had never lived with his mother. As a

result, he called his foster care parent “mommy.” The center director worked with the

guardian and Michael’s mother to encourage Michael to see his biological mother as a

primary caretaker, introducing him to “mommy Carol” (the foster parent) and “mommy

Alice” (the biological mother). When Michael was abruptly moved to a new foster home,

Alice insisted on being referred to as “mommy” and having Michael call his foster

mother by name. Attentive to the need to help Michael with this transition, Center staff

introduced the term “mommy-mommy” for Alice. After a two-month period, Michael

spontaneously began calling Alice “mommy” and looking to Alice when he needed

help.369

Such innovative strategies were not limited to interpersonal relationships;

evaluation reports and additional program initiatives laid bare the reproductive labor of

family making and maintenance constrained by punitive institutions. The complex

network required to make “mothering from prison” a reality—one that also foregrounded

inmates’ parental authority—was astounding. Foster parents had to be willing

participants in the program if the children were actually going to make it through the

prison doors into the children’s center. Participation was not only a logistical and fiscal

challenge given that travel to FCI often took up the bulk of foster parents’ weekend

hours, but it also entailed the emotionally taxing component of learning how to “share”

368 Ibid, 11. 369 Ibid, 11-12.

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parenting with the mothers at FCI. Foster parent orientation classes were regularly

offered so that guardians and mothers could develop “co-parenting models” for the

children participating in the program.370 Such coordination extended beyond individual

foster parents to child welfare services in order to address public aid for the children,

unsafe living situations, and even custody battles. Meanwhile, the leadership of inmate

staff cultivated by the program needed to be balanced against FCI staff’s authority over

inmates. In 1980, FCI Pleasanton became co-correctional, providing the program with yet

another challenge of making their very clearly mother-centered services available to

men.371

The effort to foreground the involvement of inmate mothers despite their

significant constraints extended beyond the program’s immediate objective of

strengthening mother-child bonds. Prison MATCH repeatedly emphasized not only its

commitment to inmate leadership, but also its belief that “programs like this one must be

developed from the start with the fullest possible participation by inmates.”372 Those with

far more mobility on the “outside” consistently worked to make such participation

possible for those on the “inside.” Inmate staff served on the organization’s advisory

board, worked in the children’s center, and were involved in decisions ranging from

interviewing candidates for the center director position to future program initiatives.

Because the CDA training did not qualify as a prison work assignment, Prison MATCH

370 Still, foster parents had to be invested in the goal of reunification between mother and child and the center struggled with less than enthusiastic guardians who believed incarcerated mothers did not deserve to see their children, ibid, 31. 371 FCI Pleasanton’s shift to co-corrections did not result in Prison MATCH changing its image or mission beyond the operations of the center. Its materials remained very clearly committed to women inmates and their children. 372 “Prison Match: A Model Program for Imprisoned Mothers and Their Children,” n.d., p. 6, Private Collection of Denise Johnston.

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compensated inmates who participated.373 Inmate staff saw their participation as vital in

order to “provide the real expertise on issues of parental imprisonment.” Deeply aware of

the stigma brought by incarceration, inmates, particularly those serving on the advisory

board with other community and correctional staff, considered the work a “small step

toward breaking down those stereotypes…As Board members observed significant roles

being assumed by inmates, they were forced to examine their own stereotypes.”374

But even for all the complex maneuverings enacted to make weekly visits a

sufficient source of intimate attachment on the part of both a woman and her child, the

negative effects of maternal incarceration quickly spilled beyond the Children’s center

walls and the existing staff’s capacity. Pregnant inmates turning to Prison MATCH

prompted staff to take on the issue of adequate prenatal support and delivery

accommodations for inmates.375 Desperately needed social services support was also

necessary if mothers were going to have any involvement in their child’s well-being

during the long spans of time in between visits. The program recruited the services of a

social work intern on a temporary basis, but funding—an issue that would continue to

plague the program—was a challenge. Inmate staff reported the significance of this

absent component in just the second year of Prison Match’s operations:

We have recently lost a member of the Center staff who was actively involved giving social service aid to the mothers here. We cannot express emphatically

373 “Prison Match: The Pleasanton children’s center, Mid-Year Report, June-December, 1980,” Jan 8, 1981, By Yvette K. Lehman for NCCD, p. 19-20, Private Collection of Denise Johnston. 374 “Prison Match/PCC Advisory Board,” Prepared by Janine Bertram and Carla Lowenberg, n.d., p. 1, 3; “Inmate Staffing Manual,” June 1982. Both files from Private Collection of Denise Johnston. 375 Staff arranged for inmates to have access to a birth center at a nearby hospital where they could use the services of a midwife. They also set up counseling program for pregnant women adjacent to the children’s center. This effort would eventually prompt a study of perinatal services in three Bay Area correctional facilities, funded by the State Department of Health Services and undertaken largely by Carolyn McCall. The negative findings of the report no doubt contributed to strained relations between the program and prison officials. See “Pregnancy in Prison: A Needs Assessment of Perinatal Outcome in Three California Penal Institutions,” Carolyn McCall, Jan Casteel, Nancy S. Shaw, June 1985.

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enough the need for a social service component in PCC. This need has been highlighted at board meetings and at inside staff meetings. We badly need casework assistance in handling such problems as working out custody arrangements for our children, setting up good foster care, making the right decisions for children who are residing in another state while their mother is here, etc. Our immediate concern is that, now that we have identified this need are planning new program directions, what can we do with the problems that arise in the meantime?376

Inmates were not the only ones asking this question. The Center Director had also

become a source of support for FCI correctional staff who felt “stymied in these cases,

not knowing enough about community-based resources for children with problems and,

often, not having the particular social service expertise that is needed to even decide what

kind of referral to make for a family.” Yet rather than see this lack of expertise as a

problem of inadequate training on the part of correctional staff, it was taken as evidence

that “outside” programs like Prison MATCH were all the more necessary inside prisons.

Professionals from community organizations needed to go into prisons to perform the

much-needed services related to maternal incarceration—correctional staff were not fit

substitutes. Prison MATCH materials repeatedly emphasized the specialized knowledge

required of anyone that might start such a program inside a correctional facility by

highlighting the limitations of correctional staff. “Prison staff are not trained to be

advocates for families—in fact, their role as guards prohibits it.”377 For better or worse,

the program wanted to carve out a special domain in a world otherwise run by

correctional officers; they were not interested in training regular prison staff in how to

assist this new population of prisoners.

376 “The Pleasanton children’s center Program, Quarterly Progress Report, July-September, 1979,” Oct 11, 1979, NCCD, p. 2, Private Collection of Denise Johnston. 377 “A Small Victim is Doing Time…Information about Maternal Incarceration,” n.d., p. 8, private collection of Denise Johnston.

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Prison MATCH forged ahead in fulfilling multiple roles and garnered more and

more attention as a result. Support for the program from the FCI Warden as well as the

program’s ties to NCCD quickly resulted in interest from those working in corrections. In

its second year of operation, Prison MATCH reported that it was “becoming somewhat

difficult to balance focusing in on our ongoing concerns at Pleasanton with requests for

various kinds of information and assistance from other communities. We have tried to

balance both, however, because intrinsic to this model is its bridging of institutional life

with the outside world.”378 This commitment enabled the consultant arm of Prison

MATCH to grow significantly over the next ten years of operation. With support from

the National Institute of Corrections (NIC), the organization began making a concerted

effort to replicate the program at other correctional institutions in 1982. The goal was to

establish parent/child programs in all women’s prisons based on the experiences gleaned

from the Pleasanton model while also learning about other programs happening across

the country.379 Requests came from the Michigan Department of Corrections, Maine

State Department of Corrections, New York Department of Corrections, and various

Sheriff’s departments in California, among others, and whenever possible, Prison

MATCH went to offer in-person assistance.380 Between 1978 and 1989, Prison MATCH

378 Ibid, 38. 379 For example, the Warden at the South Dakota Women’s Correctional Facility wrote back to Prison MATCH informing them of their own parent/child program called Parents and Children Together (PACT) that allowed children to stay with their mothers at the institution for a week each month, and asking for assistance in locating funding sources, Letter to Carolyn McCall and Carla Lowenberg from Lynne Delano, Dec 13, 1982, Private Collections of Denise Johnston. 380 “Objectives and Needs for This Assistance,” Day Care Council of New York, Inc, n.d.; “children’s center/Parenting Program at the Bronx House of Detention for Men,” Osborne Association, Inc., October 1984; “Helping Incarcerated Parents,” Maine State Department of Corrections, Dec 30, 1987; “Technical Assistance by Prison MATCH to the Michigan Department of Corrections,” NIC Technical Assistance, October, 1987. All files from private collection of Denise Johnston.

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successfully helped establish programs at the federal, state, and county facilities in over

seven states.381

But it was not only outside staff that considered Prison MATCH to be a model

program needed in all correctional facilities; inmate staff were also deeply committed to

outreach work that would raise awareness about their plight and the plight of their

children. Writing in just the second quarterly report for the program, inmate staff offered

their perspective on the differences between sending men and women to prison: “When a

man goes to prison, his woman on the outside will usually do everything in her power to

keep that broken home together. On the other hand, when a mother goes to prison, quite

often there is no husband there on the outside, and we can easily lose contact with our

children. Often people in control of our children have little or no interest in bridging the

gap between us and our kids…How can we make people understand our needs as women

and mothers while we are imprisoned?” For these inmates, participating in workshop

discussions and conference presentations were not just about promoting Prison Match,

but an opportunity to “publicize our needs as imprisoned mothers and the needs of our

children.”382

In a newsletter to supporters, Prison MATCH described how “the first years,

1978-1982, were full of growth, change, and excitement.”383 Probably unintentional, this

demarcation signaled the beginning of the end of Prison Match’s favorable standing with

381 “Prison Match: Programs Needed in Federal Prisons for Women. A Proposal to Congress and the Bureau of Prisons,” n.d., p. 9-10, Private Collections of Denise Johnston. 382In addition to participating in organized presentations at community agencies, conferences, and open houses hosted by the prison, inmates also developed a video of the program for distribution and wrote to media outlets requesting coverage. “The Pleasanton children’s center Program, Quarterly Progress Report, July-September, 1979,” Oct 11, 1979, p. 2-3; letter to Bob Lange from Barbara Mouzin, Feb 28, 1985. Both files from Private Collection of Denise Johnston. 383 “Brief History of Prison Match—1978-1987,” n.d. Private Collection of Denise Johnston.

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the BOP. Unsurprisingly, the tension began over funding but quickly grew as the fate of

the program and women incarcerated at FCI became linked to broader shifts in federal

corrections far beyond Prison MATCH’s control. In 1982, “seed” money from the

foundation that had provided the majority of funding to implement the program as a pilot

had run out, and the organization was spending more time and energy on fundraising

efforts. At the same time, the organization began to feel the pressure of government

spending cuts when the BOP sacrificed programs for prisoners in the face of a 12 percent

budget decrease—Prison MATCH was ranked last on the list of optional programs.384

This uncertainty, combined with the strong belief that federal prisons housing women

should bear fiscal responsibility for necessary services, prompted Prison MATCH staff to

lobby Congress for a line item on the BOP budget that would fund children’s centers at

the four federal facilities housing women.385 From 1985 to 1987, Prison MATCH

successfully won contracts from the BOP as a result of this line item; the funds, however,

covered only one-third of their operating expenses.386

This process was also incredibly precarious, as the line item was not mandatory

and the BOP was in no way required to contract specifically with Prison MATCH.387

384 Through some last minute appeals, the organization was able to secure the annual $13,000 grant from the BOP for that year, “Prison Match: Programs Needed in Federal Prisons for Women, A Proposal to Congress and the Bureau of Prisons,” n.d., Private Collection of Denise Johnston. 385 At this point—1985—there was also a program at the federal prison in Fort Worth, TX, which was being run as a co-correctional facility. It was called Prison PACT. Prison MATCH staff was committed to making sure programs were also implemented at the federal facilities in Lexington, KY and Alderson, West Virginia so that all four prisons housing women would have the program. “Prison Match: Programs Needed in Federal Prisons for Women, A Proposal to Congress and the Bureau of Prisons,” n.d., p. 13, Private Collection of Denise Johnston; “Brief History of Prison Match—1978-1987,” n.d. Private Collection of Denise Johnston. 386 Prison MATCH received $50,000 from the BOP during these years. It made up the rest of the funds from foundation grants and community fundraising, “Prison MATCH History, Prepared for Pleasanton children’s center Orientation Program: First Draft,” n.d., Private Collection of Denise Johnston. 387 See letter to Carolyn McCall and Janine Bertram from Robin, November 14, 1986, Private Collection of Denise Johnston. In 1986, the BOP nearly cut funding to the program for a second time. See “Prison

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While the organization began lobbying for an amendment to the Department of Justice

Authorization Act that would both mandate funds and do away with the “sealed bid

method” of procuring contracts, punitive sentencing legislation that had been passed

starting with the Sentencing Reform Act of 1984 began to show its effects. The

overcrowding that had pressed state facilities in the late 1970s was now being felt at the

federal level. In an attempt to find room for newly sentenced offenders, federal

corrections began shifting the makeup of its facilities. In addition to double-bunking

inmates and housing prisoners far outside of their jurisdiction, the federal system began

contracting state and county facilities to hold federal prisoners. Federal institutions that

had been co-correctional transitioned to all-male facilities, dispersing women to all

regions of the country in the process.388

FCI Pleasanton was not spared from this massive, crisis-mode redistribution of

prisoners—250 female prisoners were transferred to state and county facilities in

Washington and a county jail in North Dakota. Being thrust into a county system meant

that the women were subject to the resources—or lack thereof—available at the various

institutions. In addition to not having the services of Prison MATCH to aid in

maintaining some control over their children’s lives, women reported the lack of a law

library, counseling services, vocational training, and prison jobs, evidence of the stark

contrast between federal and municipal institutions and budgets. Many of the women had

MATCH Amendment: Statement in Support of Amendment to H.R. 1400 Department of Justice Appropriation Authorization Act, Fiscal Year 1988,” Representative Patricia Schroeder, n.d., Private Collection of Denise Johnston. 388 Peter Kerr, “War on Drugs Straining Jails U.S. Prison Officials See Overcrowding Getting Worse,” Chicago Tribune, September 25, 1987. The overcrowding of state facilities also taxed the federal system, undoubtedly contributing to the eventual capacity issues at federal institutions. For example, D.C.’s early problems with overcrowding meant that numerous inmates were sent to federal institutions. For women, this meant going all the way to Alderson, West Virginia as it was the closest federal facility for women. See Sari Horwitz, “D.C. Leans on U.S. Prisons; More Than 2,000 Local Inmates Housed in Federal Facilities, Washington Post, August 25, 1988.

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counseling or drug treatment mandated as part of their sentence, and were unsure about

what their break in treatment would mean for their parole chances. Their ability to

address these grievances was almost nonexistent as county officials repeatedly reminded

them that they were not responsible for federal prisoners.389 Inmates involved with Prison

MATCH wrote the staff in hopes of getting assistance. One woman explained that her

court-ordered visits with her son were not applicable in the state of Washington, leaving

her with the possibility that she might not see him again before the date set for his

adoption.390 Another expressed her distress at not being able to communicate with her

four young children whom she regularly saw at the children’s center.391 Another who was

serving a fifteen-year sentence wrote “How can I make it not knowing what is happening

to my family?”392

Prison MATCH staff wrote letters to the Director of the BOP and informed

Congressional committees of the effects prison transfers were having on women and their

children.393 They challenged a number of efforts the BOP was undertaking in the face of

overcrowding, including the shift away from co-corrections, the transfer of women to

institutions far from their homes, and future plans to build new cells for women in highly

secure facilities rather than transition them to community corrections. “Prison MATCH

and our many colleagues and related agencies around the country are questioning the

wisdom of these BOP practices in light of the longer view needed to improve family ties

389 Notes by legal advocate, December 11, 1987 and Letter to Congressman Thomas S. Foley from Lewis M. Schrawyer, December 23, 1987, Private Collection of Denise Johnston. 390 Letter to Carolyn McCall from Dolores Irving, January 4, 1988, Private Collection of Denise Johnston. 391 Letter to Ellen Barry and Carolyn McCall from Katherine Davenport, December 27, 1987, Private Collection of Denise Johnston. 392 Letter to Carolyn McCall from Lydia Estrada, December 1, 1987, Private Collection of Denise Johnston. 393 Letter to Michael Quinlin from Janine Bertram, December 11, 1987. Private Collection of Denise Johnston.

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so as to reduce recidivism.” In spite of their pleas, the BOP informed Prison MATCH and

the sister organization at Ft. Worth that their annual grant would be cut in accordance

with the reduced number of women inmates at each facility. 394

In 1989, the BOP contracted a different agency to provide services to parents at

FIC Pleasanton, an organization that submitted a lower bid. In notes from Prison

MATCH staff’s continued efforts to make BOP funds legally binding, staff members

attribute this move to growing anger on the part of BOP officials at Prison MATCH’s

increasingly oppositional advocacy. But in addition to whatever personal vendetta that

may or may not have been directed at Prison MATCH, staff members doing the lobbying

also cited a general lack of will on the part of prison officials. “The BOP has said

repeatedly to us and to Congress that they view these projects as ‘special interests,’ and

they do not like being told to cater to some groups over others. I guess one way to look at

women and children is as ‘special interests.’”395

The origin stories of the Mother Infant Care Program and Prison MATCH

illustrate the numerous difficulties mothers, children, and advocates faced in their

attempts to make mothering from prison a reality. These difficulties stemmed from a

fundamental question: how should the reproductive labor formerly performed by

incarcerated mothers be addressed? Advocates and inmates did not use the language of

labor, but the case of Prison MATCH in particular shows that mothering entailed far

more than emotional comfort for mother and child. Both argued that women were entitled

to continue this aspect of their lives, personally as well as professionally, in spite of their

394 Fall/Winter 1988 Effects on Inmate Mothers and Children of BOP Policies and Practices to Reduce Prison Overcrowding,” Submitted by Prison Match, February 11, 1988, p. 4-5, Private Collection of Denise Johnston. 395 “Notes on Congressional Visit, Early March, 1989, Prison Match,” n.d., Private Collection of Denise Johnston.

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incarceration. For a time, federal corrections was willing to allow women to do just that.

However, when this arrangement started to get in the way of BOP functioning,

correctional officials’ answer to the question became clear. The reproductive lives of

inmates was not the purview of the prison; it would not significantly alter its function or

structures to accommodate this reality even as its female population grew. For state and

federal corrections to respond to women’s desire to mother from behind bars, they would

need to be pressed from the outside, and even this would have limited results for women

in prison and their children.

Conclusion

The 1977 LEAA-funded national study of women’s correctional programs

reported that the “newest trend in community-based programs involves residential

facilities for mothers and children.”396 However, the researchers could not have

anticipated just how robust such a “trend” would need to be to keep pace with the rising

number of incarcerated women. By 1993, there were 90,000 women incarcerated in

prisons and jails; over two-thirds of these women were mothers.397 The number of

women in state and federal prisons increased sevenfold between 1980 and 2000.398

Perhaps best illustrated by California’s astounding trajectory of twenty-three new state

prisons built since 1984, prison construction—not “community-based programs”—has

396 Ruth M. Glick and Virginia V. Neto, “National Study of Women’s Correctional Programs,” Washington, D.C., National Institute of Law Enforcement and Criminal Justice Law Enforcement Assistance Administration, United States Department of Justice, June 1977, p. 208. 397 Katherine Gabel and Denise Johnston Eds., Children of Incarcerated Parents, Lexington Press, 1995, p. 9. 398 Natalie J. Sokoloff, Barbara Raffel Price, Jeanne Flavin, “The Criminal Law and Women,” p. 11, in The Criminal Justice System and Women: Offenders, Prisoners, Victims, and Workers, Eds. by Barbara Raffel Price and Natalie J. Sokoloff, McGraw Hill, 2004.

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defined the nation’s response to the ever-increasing number of people sentenced to serve

time.399

One way to evaluate mass incarceration from the perspective of advocacy on

behalf of mothers in prison is to conclude that gendered appeals to rehabilitation did not

rescue penal reform, not even for the “mother-prisoner.” A 1992 study of women in

prisons and jails in eight states found that over half of them had not seen their children

since being incarcerated, with distance being the main reason why such visitation was too

difficult.400 Even though new facilities for women were being built at an alarming rate,

they were largely located far from urban centers where the majority of prisoners’ families

lived. This has defined prison construction in general—correctional facilities are

incredibly difficult to get to, especially for families who cannot afford the cost of travel.

Organizations dedicated to facilitating visitation between prisoners and their families

have documented the increasingly repressive nature of penal institutions that cut

programs in the face of overcrowding. More prisons have not resulted in greater

accessibility for those on either the inside or the outside.

However, the effects of advocacy efforts on behalf of mothers in prison are

slightly more complicated than failure suggests. Correctional facilities have had to

acknowledge, at least in rhetoric, the needs of women in prison, and more so than

anything else they have acknowledged their maternal responsibilities. As such, another

way to evaluate the efforts begun in the 1970s is to trace the imperfect ways the needs of

women prisoners have been absorbed by correctional institutions and the culture at large.

399 Ruth Wilson Gilmore, Golden Gulag: Prisons, Surplus, Crisis, and Opposition in Globalizing California, University of California Press, 2007, p. 7. 400 Barbara Bloom and David Steinhart, “Why Punish the Children?: A Reappraisal of the Children of Incarcerated Mothers in America,” NCCD, 1992, p. 26.

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By and large, alternative, child-friendly visitation programs have been incorporated into

women’s facilities and are far more common than community-based programs that allow

women to live with their children.401 Prison MATCH can be credited for many of these

programs, as they have typically borrowed some of the programmatic elements of the

MATCH model to create scaled back versions of the original operation at FCI

Pleasanton.402

Yet while advocates and even some correctional officials see women and their

children as victims of structural inequality, the criminal justice system sees only their

crimes. In other words, the treatment principle that advocates for mothers in prison have

tried to keep alive, if only for the “fairer sex,” more often than not runs up against

institutions and cultural logics built upon a disavowal of the rehabilitative ideal. A 1994

issue of Center for Juvenile and Criminal Justice Report offered what should by now be

a familiar refrain. “Separation from children is often considered one of the most

damaging aspects of imprisonment for women.”403 Yet such emotional appeals to

women’s lived maternal suffering, along with romanticized appeals to mother-infant

bonding and structural appeals to women’s role as primary caretakers, have been largely

illegible within the present criminal justice landscape.

This illegibility is compounded by an unwillingness to assign responsibility for

the reproductive labor of mothering to anyone but the incarcerated mother herself. The

balancing act of mobilizing institutional resources to mitigate the constraints on mothers

401 While lack of political will on the part of state legislatures is certainly important here, community resistance to programs for “convicts” is also an important part of the story that I will need to go into in greater detail when I revise. 402 Ibid, Appendix. 403 Barbara Bloom, Meda Chesney Lind, Barbara Owen, Center for Juvenile and Criminal Justice Report, May 1994, Folder “Reports/Newsletters”

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in prison whilst protecting mothers’ parental responsibilities from those same institutions

is incredibly delicate. Advocates who yoked rehabilitation to motherhood did so in an

attempt to leverage corrections to lift constraints on mothers and in the process made the

latter project of protecting their parental responsibilities far more difficult. Invoking

rehabilitation allowed advocates to collaborate with correctional officials and garner them

access to inmates, but this also conceded that incarcerated mothers—not the criminal

justice system or structural inequalities—were responsible for their own failures as

mothers and in need of parenting aid from the institution responsible for their

punishment. Advocates’ desire to prevent corrections from administering this treatment

in an effort to get women quality care only increased corrections’ ability to refuse to

accommodate women’s reproduction. Additionally, remaining wedded to the

rehabilitative framework out of a desire to address women’s immediate situations of

incarceration distracted advocacy efforts from broader shifts in punitive sentencing that

also refused to take into account women’s reproductive labor.404 The legacy of these

strategies continues to have mixed results for incarcerated women and their children.

404 For example, it was not until 1993 that groups in California began recommending that sentencing laws be changed for those who were the primary caretakers of dependent children. This link obviously needs to be developed more, but I think the focus on maintaining family ties for women and children already affected by incarceration had costs when it came to identifying the root cause of the crisis of caregiving caused by mass incarceration. See Senate Concurrent Resolution 33, Commission Report on Female Inmate and Parolee Issues: Final Report, June 1994, p. 13-16.

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CHAPTER FOUR

Fertile Ground, 1990-2010

Introduction

Among the glossy pages of a 2009 report on pregnancy resource centers (PRCs)

published by the Family Research Council is a section entitled “Community Networks

and Public Health Linkages.” The words “Resources and Referrals” written in light

purple script against a dark purple page provide the background for an alphabetized list of

nearly one hundred organizations and programs, ranging from Medicaid to Christian

Counselors to Domestic Violence Support, all typed in bold white. Readers are told “the

significance of facilitating active community referral is borne out in the centers’ success

in overall enhancement of maternal and child well-being. The list of agencies to which

centers link is impressive. PRCs play an active role in caring for the whole woman—

including both physical and psycho-social needs.”405

Those who founded the emergency pregnancy services (EPS) movement in

response to liberalized state abortion laws had a short term goal based on an assumption:

develop emergency pregnancy counseling in order to support women facing an

unplanned pregnancy, none of whom would abort if provided with meaningful

alternatives. In the minds of EPS counselors, unexpected pregnancies, particularly for

unmarried women, presented a potential crisis given the increasing availability of

abortion. Without available alternatives, they worried that women would see abortion as

405 Care Net, Family Research Council, Heartbeat International, LIFE International, and National Institute of Family and Life Advocates. “A Passion to Serve, A Vision for Life: Pregnancy Resource Center Report 2009.” Family Research Council. P. 28-30.

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the only solution to their “emergency” pregnancies. EPS centers aimed to intervene and

offer the support necessary for women to see childbirth as a viable option, regardless of

circumstance.

As societal shifts around gender roles, extramarital sex and childbirth, and

marriage sped up rather than reversing course during the 1970s and 1980s, however,

volunteers dedicated to providing alternatives to abortion were faced with the inadequacy

of this outlook. In addition to many women genuinely wanting abortions regardless of

their religious or philosophical beliefs on life, the pregnant clients centers encountered

needed much more than crisis intervention counseling to make it through their

pregnancies. 406 In a 1984 issue of Heartbeat Magazine, Alternatives to Abortion

International (AAI) co-founder Sister Paula Vandegaer updated readers on emerging

areas of “pregnancy services.” “One of the greatest needs in the U.S. right now is for

housing for pregnant women. Many groups all over the country are starting short-term

and long-term housing. Another growth area is after-delivery services. Many pro-life

groups are now in a position to consider after-delivery services and are offering group

counseling, day care centers, residence, and other after-delivery supportive services for

women and children.”407

As many EPS centers attempted to adapt to the needs of their clients in an effort

to help them through their pregnancies, pro-life volunteers providing alternatives to

abortion moved further into the world of service provision. In the process, PRCs, also

406 AAI’s Heartbeat Magazine, for example, published a story on the “repeat aborter” in its Winter 1983 issue. Heartbeat, Vol. 6, No. 4, Winter 1983, p. 22, International Life Services Internal Records. See also Heartbeat Magazine, Vol. 3, No. 4, Winter 1980, p. 4-5, bMS 438/1, George Hunston Williams Papers, Abortion Collection, Harvard Divinity School. 407 Heartbeat Magazine, Vol. 7, No. 4, Winter 1984, p. 7, bMS 438/3, George Hunston Williams Papers, Abortion Collection, Harvard Divinity School.

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known as crisis pregnancy centers (CPCs), became further enmeshed in a network of

support agencies serving pregnant women reliant on public and private aid.408 Those

committed to ending abortion by providing alternatives soon faced a new problem. By the

late 1990s, the majority of centers’ clientele were pregnant women with no intention of

aborting but instead in search of services to help them during pregnancy and after

childbirth. Recent estimates by current CPC movement leadership show that only 20

percent of clients are considering abortion.409

In 2015, the pro-choice organization NARAL published a report titled “Crisis

Pregnancy Centers Life: The Insidious Threat to Reproductive Freedom.” A compilation

of information culled from various NARAL state affiliates’ undercover investigations

into CPC operations, the report argued that “The American anti-choice movement has

built thousands of outposts across the country with the sole purpose of preventing women

from accessing abortion (through lies and coercion), and they’re hiding in plain sight.”

NARAL investigators posing as pregnant women recorded the various tricks used by

CPCs, including lying to women about the health risks associated with abortion and birth

control and the “co-location strategy” of establishing a center in the same buildings as

Planned Parenthood and women’s health clinics. “It is time,” the report warned readers,

“to recognize CPCs for what they are: a grave threat to a woman’s right to choose.”410

408 I referred to the movement and centers with the “EPS” acronym in Chapter One because that was how the majority of the pro-life movement understood alternatives to abortion. In this chapter I use “CPC” because that is the most commonly used referent. I suppose one could argue that I should use “PRC” to better reflect the political actors engaged in the movement currently, but I think CPC is more widely recognized. 409 Kimberly Kelly, “In the Name of the Mother: Gender and Religion in the Crisis Pregnancy Center Movement,” Dissertation submitted to University of Georgia, 2009, p. 229. 410 “Crisis Pregnancy Centers Life: The Insidious Threat to Reproductive Freedom,” NARAL Pro-Choice America, written by Lisa McIntire, 2015.

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In this chapter I examine the expansion of pro-life service provision since the

early 1990s. In doing so, I attempt to reconcile the movement’s self-reported failure to

reach “abortion-minded” women—pregnant women who want an abortion—with the pro-

choice movement’s understanding of CPCs as a threat to choice. I argue that a framework

of choice has obscured two important facts about the contemporary “pregnancy resource

movement.” First, seeing CPCs solely as a threat to choice requires ignoring the reality

that CPCs are far more successful in their service provision to poor and low-income

pregnant women than in their mission to make abortion obsolete. Second, focusing only

on CPC’s desire to keep women from obtaining abortions misses the ways CPCs have

become increasingly embedded in a network of public and private aid aimed at pregnant

women and their children. The pro-life volunteers that warn women seeking abortion

services about the horrors of “post-abortion syndrome” are the same women who are far

more likely to spend their volunteer hours making sure pregnant women are signed up for

WIC, Medicaid, and prenatal classes.

Rather than attribute this reality solely to the success of the pro-life movement, I

suggest that we see the expansion of pro-life service provision in the context of state and

federal welfare retrenchment. I argue that a major reason CPCs have managed to enjoy

immense growth, both in terms of the number of centers and the consistent flow of

clients, is because they fill a service gap created by the massive restructuring of

government funded social services. Disinvestment in community health centers,

deregulation of federal funds allocated for maternal and child health, welfare reform, and

federal restructuring of Medicaid have created a landscape that has enabled this

movement to thrive since the mid-1990s. In a post-Roe era where pregnancy and

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motherhood are the purview of private, individual responsibility, pro-lifers that

understand structural inequality through the lens of a culture of poverty and believe in

compulsory motherhood are poor and low-income pregnant women’s biggest advocates.

This cannot be attributed solely to the success of pro-lifers but must also be seen as an

effect of a concerted effort to privatize motherhood.

I illustrate these claims through an exploration of developments in the CPC

movement since the 1990s. I begin with the rebranding strategy the movement undertook

in an attempt to salvage its tarnished image as deceptive, “bogus clinics.” The highly

publicized commitment to “compassionate care” went a long way toward restoring the

movement’s reputation, while substantial legal strategizing insulated centers from

additional lawsuits. Yet in the context of volatile debates over welfare, the renewed

commitment to care created a new image problem for the movement, and CPCs became

the target of pro-life critics concerned that centers were contributing to single

motherhood. I explore the movement’s use of abortion and race to negotiate these

accusations by examining CPCs’ recent efforts to expand into predominately Black and

Latino urban neighborhoods that have been demarcated “areas of greatest need.” This

“Urban Initiatives” campaign has enabled the movement to collaborate with pro-life

religious leaders of color, gaining access to communities that would otherwise be

inaccessible to white, middle-class, suburban volunteers.

I end the chapter with an admittedly experimental approach of exploring these

broad developments in a more specific and grounded context. I examine the growth of

pro-life service provision in Pennsylvania, particularly the city of Philadelphia. It is here

that I attempt to link CPC expansion to the massive restructuring of federal and state

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welfare aid. In highlighting the disparity between the maternal and child health needs of

the city and the availability of services, I recast CPCs in a framework of structural

inequality wherein centers play a role in alleviating the effects of poverty, violence, and

racism in pregnant women’s lives. By depicting the landscape of pro-life service

provision in Philadelphia, I highlight the necessity of these services while arguing that

their very indispensability reveals just how little we value motherhood in the United

States.

Rebranding and Professionalization

If the majority of Americans were unfamiliar with the service-based arm of the

pro-life movement in 1980, a string of lawsuits ensured they were well acquainted, if not

on the best terms, by the end of the decade. Suits against centers for deceptive advertising

in over ten states had turned crisis pregnancy centers into “bogus clinics” that tricked

women by claiming to provide or refer abortions.411 Congressional hearings dedicated to

the topic further cemented this understanding by using the same “bogus clinic”

terminology and reportedly refusing to let any representatives of the alternatives to

abortion movement provide testimony. 412 By the early 1990s, centers claiming to offer

411 Landsberg, Michelle, “‘Fake abortion clinics’ a pro-life front for emotional violence,” The Globe and Mail, October 11, 1986; Jane Gross, “Pregnancy Centers: Anti-Abortion Role Challenged,” New York Times, January 23, 1987; Kevin Sullivan, “Group Pickets Antiabortion ‘Clinic’ in MD,” Washington Post, November 3, 1991; William H. Freivogel, “Supreme Court Shuts Door on Suit Against Fake Clinic,” St. Louis Post-Dispatch, Jan 14, 1993. 412 Reports written by leaders in the movement criticize Representative Wyden for not inviting anyone to represent the viewpoint of crisis pregnancy centers, and it is true that all of the witnesses who spoke argued that clinics were using deception. “Consumer Protection and Patient Safety Issues Involving Bogus Clinics,” Hearing before the Subcommittee on Regulation, Business Opportunities, and Energy, Committee on Small Business, One Hundred Second Congress, Sept 20, 1991, p 1. For pro-life materials that claim Wyden deliberately excluded representatives of the movement see “Around the Nation” NIFLA Legal Updates, Vol.1 No. 1, July/Aug 1993. Folder 45:33, Box 045, 1st Amendment Studies Papers, Tufts

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“pregnancy counseling” were thoroughly associated with the radical element of the pro-

life movement that used extreme and sometimes violent tactics to stop women from

obtaining abortions. However, the Evangelical pro-life organization Christian Action

Council (CAC) ensured the CPC movement’s survival. The policies CAC developed for

its affiliates would become the policies for the movement as a whole.

In 1992, Beth Diemert, president of a coalition of CAC affiliated centers in

Pittsburgh, published an editorial in the Wall St. Journal. Titled “Supporting Her Choice

When It Isn’t Abortion,” the editorial aimed to set the record straight on the alternatives

to abortion movement’s commitments and practices. As an affiliate of CAC, Diemert’s

coalition was bound by policy not to advertise under “Abortion” in the yellow pages.

Fully aware that “our opponents are hungry for evidence that we brutalize already

traumatized pregnant women,” Diemert distanced pro-life counseling from the centers

accused of using scare tactics by assuring readers that “CPCs are committed to doing

what it takes to show that our concern for women is unselfish, unmanipulative, and

unconditional.”413

The CAC policies governing Diemert’s Pittsburgh centers would soon become the

official protocol for centers across the country. Suits against centers and legislation aimed

at curbing deceptive advertising continued through the first half of the 1990s, causing

leaders of the movement to declare that crisis pregnancy centers were under “attack.”414

University; Hartshorn, Peggy. Foot Soldiers Armed with Love: Heartbeat International’s First Forty Years. Walsworth Publishing Company, 2011, p. 84. 413 Diemert, Beth, “Supporting Her Choice When it Isn’t Abortion,” Wall Street Journal, Jan 22, 1992, A14. 414 For example, a case against a clinic in San Diego, CA in 1994 barred the use of misleading advertising and performing pregnancy tests. Tamar Lewin. “Anti-Abortion Center’s Ads Ruled Misleading.” New York Times. Apr 22 1994. A15. Additionally, legislation in California and Virginia along with decisions from District Attorneys in Maryland and Ohio attempted to regulate the advertising content of centers. “Around the Nation” NIFLA Legal Updates, Vol.1 No. 1, July/Aug 1993, p. 1-3, Folder 45:33, Box 045, 1st

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In response to the “heightened activity against pro-life centers,” CAC Executive Director

Tom Glessner took the policies developed for CAC affiliates and created a new

organization dedicated to insulating CPCs from litigation. The National Institute of

Family and Life Advocates’ (NIFLA) sole aim was to provide legal guidance to pro-life

CPCs. Glessner was deeply committed to rescuing the movement from what he described

as “a highly successful negative public relations campaign to discredit the work of pro-

life pregnancy help centers.” He asserted that the campaign had started in the mid-1980s,

undertaken by “a coalition of pro-abortion organizations, led by Planned Parenthood.”

Since then Planned Parenthood had been joined by “the National Organization for

Women (NOW), the Religious Coalition for Abortion Rights (RCAR) and the National

Abortion Federation (NAF).” In Glessner’s account, the movement took the biggest hit in

1991 with the Congressional hearings on “bogus clinics,” which were highly publicized

thanks to the strategizing of the executive director of the National Coalition of Abortion

Providers Ron Fitzsimmons. “Increased activity against pregnancy centers” followed

from media reports of the hearings. 415

Glessner’s new organization of pro-life legal services was quickly embraced by

the other major umbrella network organizations. After struggling through a series of new

executive directors between the mid-1980s and early 1990s, Alternatives to Abortion

International (AAI) reemerged on the scene as Heartbeat International under the

leadership of Peggy Hartshorn. In 1993, Heartbeat International announced the creation

Amendment Studies Papers, Tufts University. Negative coverage of centers also continued in the press. Neil deMause. “Counterfeit Clinics, Genuine Pain.” On the Issues. Jan 1 1994; Elizabeth Gleick. “Politics: Where Can Pregnant Teens Turn?” Time Feb 20 1995; Rod Dreher, “A Helping Hand to Halt Abortion,” Washington Times April 6, 1995. L.A. Kaufman, “Abortion Clinics that Aren’t” Mademoiselle June 1995, p. 138. 415 “History of the Controversy,” Letter from Tom Glessner to Members Fieldstead Forum, July 30, 1993, International Life Services, Inc. Internal Records.

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of a new service available to its affiliates courtesy of NIFLA. “We all know that attacks

are being made on centers around the United States—we must protect ourselves legally to

the best of our ability.”416 With CAC and Heartbeat encouraging affiliates to adopt

NIFLA’s insurance, centers became far more insulated from the lawsuits that defined the

1980s.417

In addition to selling centers insurance that protected them from “counselor

liability,” Glessner was instrumental in convincing major leaders to form a coalition that

could collectively respond to negative claims about CPCs. In a memo to the major

organizations in the CPC movement, Glessner explained “The abortion industry has been

united in its opposition to the work of the pregnancy-help centers. And this united

opposition has been effective. To counter this the pro-life movement and particularly

those organizations which lead the development of pro-life centers, must also unite in its

response.”418

NIFLA was instrumental in rebranding the whole of the movement throughout the

early 1990s. By 1994, all the major umbrella network organizations that coordinated

CPCs had signed onto the “National Advertising Guidelines for Pro-Life Pregnancy

Service Centers,” committing their affiliates to “never portray themselves as abortion

providers” and to “accurately describe the services of the center.”419 Upon finalizing the

guidelines, Glessner reminded movement leadership that “Each of the organizations

416 Heartbeat Bulletin advertises NIFLA’s liability insurance in 1993. Heartbeat Bulletin, Heartbeat International Internal Records. 417 At this point, Heartbeat and CAC had the largest number of affiliates so their endorsement of NIFLA was significant for changing center practices. 418 “Proposal: The National Coalition of Abortion Alternative Providers (“N-C-DOUBLE A-P”),” From Thomas Glessner to Members Fieldstead Forum, July 30, 1993, International Life Services Internal Records. 419 “National Advertising Guidelines for Pro-Life Pregnancy Service Centers,” January 31, 1994, International Life Services, Internal Records.

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endorsing these standards agrees to announce the guidelines to affiliated pregnancy

centers in newsletters, correspondence, and other publications. In addition, by endorsing

these standards we have available to us a tool to promote in the media as a ‘standard’ of

the industry. Because of this, the more organizations which sign onto these standards the

greater credibility we will have when we reference these guidelines as ‘industry

standards.’”420 Through NIFLA and Glessner’s coordination, the CPC movement

gathered strength through a shared commitment to core professional principles in

addition to its shared political vision.

Leaders of the movement not only responded to Glessner’s call; they also helped

spread the pro-choice attack narrative to their affiliates. NIFLA’s brochure explained that

pro-choice organizations were attacking CPCs because they stole the “abortion

industry’s” business by convincing women to choose life.421 NIFLA’s new partners did

the same. When Sister Paula Vandeagaer left AAI in 1985, she founded a new

organization called International Life Services (ILS), Inc. Through ILS, Vandegaer

continued to coordinate a much smaller network of CPCs while also extending beyond

abortion to bring a pro-life perspective to bioethics.422 Vandeagaer told readers of the

organization’s publication Living World that the “one and a half million calls” centers

420 Letter from Tom Glessner to Sister Paula Vandegaer, Peggy Hartshorn, Doroty Wallis, Denise Cocciolone, Judie Brown, Guy Condon, March 10, 1994, International Life Services Internal Records. 421 For example, a NIFLA brochure reads “Nationwide, nearly 3000 pregnancy help centers have been targeted by the abortion industry for vicious attack. These centers save lives and that means lost income to the abortion industry.” The argument that Planned Parenthood and other abortion rights organizations target crisis pregnancy centers because they steal revenue generated by abortion procedures is widely accepted in the pro-life movement. NIFLA Brochure, Folder 45:30, Box 045, 1st Amendment Studies Papers, Tufts University. Before NIFLA sold liability insurance to centers protecting them from the actions of overzealous counselors, it had to create the insurance program. See Hartshorn Peggy, “Putting it All Together,” p. 110, in Back to the Drawing Board: The Future of the Pro-Life Movement, ed. Teresa Wagner, St. Augustine’s Press, 2003. 422 According to Vandegaer, this was one of the reasons she left AAI, so that she could participate in a broader set of debates concerning a “culture of life.” Interview with Sister Paula Vandegaer, on file with author.

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were receiving each year “has had a significant impact on the abortion industry since

most of the young people who come to these centers do not choose abortion when offered

help and assistance to have their baby.”423

Glessner’s strategy—that CPCs organizations must “unite in response”—became

the go-to protocol for tackling pro-choice campaigns targeting CPCs. When NARAL

unveiled its Choice Action Kit: A Step-by-Step Guide for Unmasking Fake Clinics

campaign in 2000, the President of Care Net (formerly the CAC) in collaboration with

Heartbeat and NIFLA, once again reached out to the major organizations and in 2001

they released Serving Clients with Care and Integrity: A Step-by-Step Guide for

Responding to NARAL’s CPC Campaign.424 Included in the report was a reiteration of the

recently agreed upon Commitment of Care that the coalition had been developing since

1999 at the urging of Care Net’s general counsel Kurt Entsminger.425 While the

guidelines originally stated that clients would be treated in a “non-judgmental caring

manner,” the national director of Christian Life Resources reminded Glessner that “faith-

based judgment is always to be void of self-righteous judgment,” but “it is not ‘non-

judgmental.’” Such “faith-based judgment involves witnessing with God’s Word which is

oftentimes very judgmental.” As a result, the number two principle was changed to

423 “Editor’s Notes: Does your Center Need to be Affiliated with a National Organization.” Living World, Vol. 9, No. 1, p. 4, International Life Services, Inc. Internal Records. 424 Harsthorn attributes the Commitment of Care collaboration to the NARAL campaign in her piece “Putting it All Together,” p. 111, in Back to the Drawing Board. Also see letter to Sister Paula Vandeagaer from Care Net General Counsel Kurt Entsminger, Aug 13, 2001. 425 Letter to Sister Paula from Kurt Entsminger, Dec 13, 1999. International Life Services Inc. Internal Records. During discussions about the national advertising guidelines, it was clear that Glessner saw counseling guidelines as the next step in protecting centers. In his proposal that major leaders form a coalition “for the specific purpose of developing and adopting uniform national standards of advertising for pro-life pregnancy help centers,” Glessner suggested that the coalition “may decide to develop uniform standards in other areas of operation such as counseling.” See “Proposal: The National Coalition of Abortion Alternative Providers (“N-C-DOUBLE A-P”),” Letter from Tom Glessner to Members Fieldstead Forum, July 30, 1993, International Life Services Inc. Internal Records.

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promise that center staff and volunteers would treat clients “with kindness, compassion,

and in a caring manner.”426 The official omission of “non-judgment” signaled the

movement’s shift to a more explicitly Christ-centered orientation, with an emphasis on

conversion.427 Whereas AAI’s earliest pro-life counseling principles included a “non-

judgmental attitude”—which AAI clarified did not require “approving of everyone’s

attitudes” but did require refraining from assigning “guilt or innocence” to a client—the

new coalition of CPC leaders embraced (or at least made room for) “witnessing with

God’s Word” when counseling clients.428

Of course, even the most compassionate, non-judgmental pro-life counselor could

not overcome the fundamental belief behind pro-life counseling—that abortion

constitutes taking a life. Explicit disavowals of “scare tactics” in counseling would fail to

quell abortion rights advocates’ concerns about fear-mongering and manipulation

because interfering with a women’s right to abortion is a violation, no matter the delivery.

True to her AAI roots, Vandegaer told readers of Living World to avoid judgmental

statements and scare techniques such as “you’ll murder your baby.” She explained, “This

type of statement implies your judgment of her as a murderer. No woman will murder,

426 Letter to International Life Services from CareNet’s General Counsel Kurt Entsminger, Feb 12, 2001; Letter to Kurt Entsminger from Pastor Robert Fleishmann, National Director of Christian Life Resources, May 16, 2000. 427 This example of more explicit Christian influence on the movement’s principles can also be found in Heartbeat’s decision to identify as a Christian organization as opposed to AAI’s decision to not identify as a religious organization. Interview with Peggy Hartshorn, President of Heartbeat, by Author, 12/12/12. Kimberly Kelly also discusses the movement’s turn to a more explicit religious identity during this period, although she describes this transformation as one specifically of Evangelical Christianity. Kelly’s observation explains the emphasis on conversion, and Kelly ultimately argues that it is ultimately this aspect of the counseling—the conversion of clients—that sustains the movement. In my research, however, I found continued religious variation, even among those considered leaders of the movement. For example, International Life Services and Heartbeat do not specify the Christian denomination of their organizations, and continue to have strong ties to Catholic social services organizations that played a foundational role in the movement’s early years. See Kelly, p. 3, 6. 428 “Counseling Tips,” AAI Education Committee-Sister Paula Vandegaer, June 1972, bMS 404/8, George Hunston Williams Papers, Abortion Collection, Harvard Divinity School.

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rather she will repress and deny the situation, refusing to look at it.” Instead, Vandegaer

instructed readers to ask women “questions that can put her back in contact with her

natural instincts; ‘If you had a baby what would you want, a little boy or a little girl?’”

and to “Call the baby a baby, not a fetus or an embryo. If she has named the baby call the

baby by name.”429 Pro-choice organizations continued to criticize and expose such

counseling tactics, but with Glessner’s well-orchestrated publicity campaign to remake

the movement as transparent and truthful, these criticisms ultimately held little sway

among those who shared the belief that life begins at conception.

Debating Pregnancy Services

In addition to making public commitments to honest advertising and

compassionate counseling, centers also began highlighting their service provision, further

promoting their professional commitment to high-quality pregnancy services. AAI’s

newsletters and literature from the 1970s and early 1980s were largely dedicated to

instructions on how to start centers and provide adequate pro-life counseling designed to

successfully intervene in a moment of crisis. Yet by the mid-1990s Heartbeat’s

newsletters were showcasing centers’ ability to either provide substantial social services

or connect women to existing resources. One Heartbeat newsletter profiled the work of an

affiliate in Columbia, Montana that had received a state license to open a home for

pregnant girls as young as eleven. The State Division of Family Services frequently

referred girls in foster care homes that had become pregnant to Bethlehem Home.

Another affiliate in Lafayette, Iowa announced its successful application for a grant that

429 Living World. Winter 1996/1997 Vol. 10, No. 2. International Life Services, Inc. Internal Records.

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would enable the center to cover prenatal care for immigrant women who were ineligible

for Medicaid due to lack of citizenship. Similarly, expectant Mother Care in New York

City praised the city’s “generous” prenatal care assistance program that covered both

immigrant women and those living up to 85 percent above the poverty level.430 Heartbeat

of Monroe began offering “childbirth preparation classes” upon learning that classes

offered by the hospital were consistently full while also creating a housing grant program

for homeless pregnant women or women with infants under one-year old.431 While it was

not unheard of for centers to receive funding support from state institutions in the 1970s,

these relationships most often consisted of informal networks of sympathetic medical and

service providers.432

While such changes signaled the start of the movement’s growing tendency to

partner with public service providers, broader political developments around welfare

would complicate this development. The Republican Party’s 1994 manifesto “Contract

with America” blamed rates of out of wedlock pregnancy on government aid to single

mothers and called for significant welfare reforms in order to “discourage illegitimacy.”

Simultaneous commitments to both pro-life and anti-welfare positions made Republicans

vulnerable to accusations that their regard for life ended at childbirth. The view

expressed by pro-choice think tank Alan Guttmacher Institute described the GOP’s

apparently impossible position on welfare. Guttmacher argued that welfare cuts,

430 Heartbeat Newsletter, Spring 1995, p 4-5, Heartbeat International Internal Records. 431 Heartbeat Newsletter, Sept 1995, p. 4, Heartbeat International Internal Records. 432 For example, in 1973 Centers in Geauga County of Ohio reported that they had received funds from the State Mental Health Board to cover psychiatric consultant fees offered by their centers and declared the development a “breakthrough in the area of securing public funding for Pro-Life EPS Centers” and an “acknowledgement of the fact that these centers do perform a service which contributes to the improvement of mental health in those persons who are distressed by pregnancy.” Heartbeat News Bulletin, Aug 1973, Vol 5, No 2, BMS 404/8, George Hunston Williams Papers, Abortion Collection, Harvard Divinity School

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particularly the family cap, “would place the Federal Government in a ‘truly indefensible

position’ by denying funds for abortion, encouraging pregnant women on Medicaid to

have babies they could not afford to support, and then punishing them by denying

benefits for the children.”433

Liberals were not the only ones opposite to the GOP agenda. Foremost among its

critics were several major players in the pro-life movement, including the U.S. Catholic

Bishops, Catholic Charities, Feminists for Life, and National Right to Life Committee,

whose public statements opposing welfare reform brought alternatives to abortion into

the national debate.434 NRLC Executive Director David O’Steen drew upon the anecdotal

experiences of alternatives to abortion services. “The typical client of a crisis pregnancy

center is young and unmarried and often comes into the center with no idea how she is

going to cope economically with that pregnancy. To increase pressure on her…we feel

will increase abortion.”435 Rejecting outright the idea that welfare reform, particularly the

family cap and child exclusion portions of the proposal, represented a pro-life strategy,

NRLC president Wanda Franz argued, “If we were to stand silently by and not have the

courage to speak out against these proposals, then we could never look anyone in the eye

again and say we support alternatives to abortion.”436 NCCB spokeswoman Helen Alvare

echoed Franz. “We grant the goodwill of those seeking to end the culture of teen

parenting. But we cannot seek a good end by evil means. We must not penalize innocent

children by cutting off their support because their mother was too young, or has other

433 Tamar Lewin. “The Nation: Abortion Foes Worry about Welfare Cutoffs.” NYT March 19, 1995. 434 L. Goldstein, “Some Antiabortion Activists Question Consequences of GOP Welfare Reform.” The Washington Post. Feb 1 1995, A4. 435 Ibid. 436 Tamar Lewin. “The Nation: Abortion Foes Worry about Welfare Cutoffs.” NYT March 19, 1995.

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children on welfare. And we cannot take action that will push women toward

abortion.”437

Those actually providing alternatives to abortion were caught in the middle of the

debate over welfare reform and abortion. As an article in Time magazine reported, “The

volunteers at roughly 3,000 crisis pregnancy centers nationwide are promoting childbirth

among the very women the Contract with America hopes to discourage from

motherhood: unwed teens and welfare mothers having additional children.”438 It did not

take long for outspoken pro-lifers to target CPCs. Quoting a veteran center director in her

editorial “Pro-Life Dilemma: Pregnancy Centers and the Welfare Trap,” pro-life author

Frederica Mathewes-Green exposed an aspect of CPCs that the movement rarely made

explicit: economic inequality. “She probably gets $225 a month on welfare, and there’s

food stamps, WIC, and medical assistance…In all these years, I’ve seen less than a half-

dozen find a way to work…We do put people on welfare. We do create single-parent

homes, but at least the baby is alive.” Using the woman’s honesty to bolster her ultimate

argument, Mathewes-Green argued “welfare causes more crisis pregnancies,” because

“welfare dollars remove the stigma of sex and pregnancy outside marriage” by “making

single-parent households possible.” The problem with pro-life counseling was that “when

counselors steer women away from abortion, they often end up encouraging single-

parenting and neglecting adoption.” Mathewes-Green urged CPC volunteers to do a better

job of encouraging adoption and marriage in their pro-life counseling 439

437 Ibid. 438 Gleick, Elizabeth. “Where Can Pregnant Teens Turn? Time. Feb 20, 1995. Folder 24:13 CAC, Box 024, MS074/002, Institute for First Amendment Studies Records, Tufts University. 439 Mathewes-Green, Frederica, “Pro-Life Dilemma: Pregnancy Centers and the Welfare Trap,” Policy Review 78, Jul/Aug 1996, 40-43, p. 40-41. Mathewes-Green has been an outspoken critic of this aspect of

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It is difficult to evaluate the CPC movement’s response to the debate over

alternatives to abortion and welfare because movement leadership had very little to say

about the issue.440 A lone Heartbeat newsletter acknowledging the “proposed changes in

the welfare system” seemed to embrace both positions, asking “Are there model

programs already operating in pregnancy help centers which can help such clients make

the transition from dependence to responsibility? Will welfare changes mean more

abortion-vulnerable women and girls?”441 What is clear is that there existed wide

variation among centers in their approach to government aid. The director of Bethlehem

Home, for example, would not allow the young women staying at the maternity home to

use WIC or welfare aid despite being a state licensed institution. Instead, the girls visited

“food banks where food is donated by individuals or charities and they accept many

donations from the community.” In contrast, teenagers at the Harbor House Home for

Unwed Mothers in Celina, Ohio were covered by the state’s Medicaid program if they

had no other medical coverage, but they were not put on welfare.442 By 1996, these

services were more likely to be framed as “earning programs” that required completion of

parenting or bible classes in exchange for material goods provided by the center that

crisis pregnancy centers. See also “Seeking Abortion’s Middle Ground” Washington Post, Jul 28, 1996; “Unplanned Parenthood,” Policy Review 57, Summer 91, p. 98. 440 It is tempting to attribute this silence to the movement’s relationship with Focus on the Family, which brought with it ties to Family Research Council. The FRC was instrumental in ultimately winning over pro-life Republicans who balked at the exceptionally punitive aspects of welfare reform. The FRC commissioned a study on pro-life support for family caps in order to counter the NLRC’s opposition and ensure the Republican vote. However, the evidence I currently have tying Care Net and Heartbeat to FOF/FRC is too weak to make the argument that CPC movement leadership was beholden to the political agenda of FOF, and needed to downplay the movement’s use of welfare as a result. For an indepth discussion of the FRC’s role in winning over pro-life Republicans see R. Kent Weaver, “Polls, Priming, and the Politics of Welfare Reform” in Navigating Public Opinion: Polls, Policy, and the Future of American Democracy, ed. Jeff Manza, Fay Lomax Cook and Benjamin Page, Oxford University Press, 2002. 441 442 Heartbeat Newsletter, Winter 1996, p. 3. Heartbeat Internal Records.

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“used to be free,” though the emphasis on service provision remained.443 In spite of

getting caught in the welfare reform debate, the CPC movement remained strong in its

commitment to pregnancy services. 444

Yet by the end of the 1990s, movement leadership was faced with a problematic

aspect of the successful push to rebrand alternatives to abortion. Two types of center

clients emerged following the rapid growth and professionalization of CPCs: those

looking to obtain abortions—“clients at risk”—and those who had no intention of

terminating their pregnancies—“services only clients.” In response to “widespread

anecdotal reports” that centers were seeing more and more women not “at risk” for

abortion and far fewer women that were, Focus on the Family (FOF) conducted a center

assessment report to help centers attract more of the “right” kind of client. Consistent

with the anecdotal evidence, the study found that a sampling of CPCs showed a 7%

increase of “services only clients” compared to a 1% increase of “clients at risk” between

1994 and1996. These trends, the report warned, “would threaten the primary mission of

Centers to reach women at risk by shifting CPCs off-center from at least two of their core

values—to save children from abortion and to show compassion to women confronted

443 For example, First Life Pregnancy Center in Orlando, FL developed the HOPE program, making items that used to be free available to women only after “watching videos, attending Bible studies, and participating in parenting classes.” Pulse Newsletter, Fourth Quarter 1997, p. 2. Heartbeat International Internal Records. Mention of welfare aid is non-existent in these letters for the latter half of the 1990s, although programs serving single mothers specifically are still highlighted during this period. 444 In interviews with the president of Heartbeat International, the president of International Life Services, and staff at the Heartbeat International headquarters it was made clear that crisis pregnancy centers depend on the availability of government aid in order to assist women in their pregnancies. Despite the criticisms, my interviewees agreed that such services are a necessity and neither organization has taken steps to limit their affiliates’ use of these programs. Interviews with Peggy Hartshorn, Sister Paula Vandeagaer, Jor El Godsey, and Betty McDowell by Author, on file with Author. Kimberly Kelly’s fieldwork with crisis pregnancy centers has also shown that centers have strong ties with state services and understand themselves to be a part of a network of support for pregnant women. See Kimberly Kelly, 210-213.

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with abortion.”445 The report also identified cultural factors responsible for the shift in

clients, such as increased acceptance of single parenthood, and found that women

responded more positively to advertisements displaying healthy and empowered women

as opposed to vulnerable women in crisis. Despite the fact that the focus groups ranked

finances as the number one concern they would have if facing an unplanned pregnancy,

the report remained focused on reaching the “abortion-minded” women even though lack

of finances also explained the disproportionate number of “services-only” clients. Unlike

reports from volunteers that did not shy away from highlighting clients’ economic

challenges, FOF’s analysis attributed low “target client” turnout to ineffective advertising

and said little else about the majority of the women centers were serving.446

By the end of the 1990s the alternatives to abortion movement had been

successfully remade and become a more substantial feature of the pro-life movement than

in prior decades. However, it now faced a new challenge. How could centers reach

pregnant women most “at risk” for abortion? While the movement had spent the 1990s

remaking its image, it would spend the next decade crafting a campaign that addressed

this question without violating its recently implemented professional guidelines.

445 Curt Young, “Assessing Center Impact—Increasing Center Effectivness,” Marketing Research Analysis presented to the Crisis Pregnancy Center Movement at Focus on the Family, Feb 5, 1998. 446 While the focus groups cited finances as the main concern they would have about an unplanned pregnancy, the report’s only mention of class differences was to lump women into two categories—those “upper socioeconomic” women who perceive abortion as an “unfair loss” because it interrupts their career path and those “lower socioeconomic” women who perceive abortion as a “deserved loss” or “personal failing.” These two categories of client are both met with solution that the center has the resources women need to get through the pregnancy. Interestingly, however, the report concludes that the convincing demonstration of adequate resources that supposedly allows lower-class women to make the decision to carry the pregnancy to term is the same thing that makes upper-class women suspicious that the center only cares about getting the woman to have the baby. Curt Young, “Assessing Center Impact—Increasing Center Effectiveness,” Marketing Research Analysis presented to the Crisis Pregnancy Center Movement at Focus on the Family, Feb 5, 1998, p 1.

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“Urban Initiatives” and the “Areas of Greatest Need” Strategy

In the early 2000s, some leaders of the CPC movement began investigating a

theory: are there fewer CPCs in areas where there are more abortion clinics? The answer

to this question would provide the movement with a new direction, one that continues to

define its current goals. Over the past decade, Heartbeat International and Care Net have

turned much of their attention to developing center operations in predominately Latino

and Black neighborhoods in urban areas. The creation of the “Urban Initiatives”

campaign has resulted in the two largest affiliate organizations more aggressively

directing center growth and pursuing partnerships with pro-life leaders of color.447

Capitalizing on pro-life race narratives that use higher rates of abortion among Black and

Latina women to argue that Planned Parenthood targets communities of color for

abortion, the urban initiatives campaign argues that the CPC movement has failed to

reach the most vulnerable of “abortion-minded clients.” This narrative has enabled the

CPC movement to explain why the majority of its clients have been “services-only” as

well as build relationships with pro-life leaders of color, diversifying what has been a

largely white, suburban movement.

The strategy of using rates of abortion and location of abortion providers to

declare certain areas “underserved” by the CPC movement most likely began with

Heartbeat International’s efforts to cultivate pro-life services in the northeast. During

regional outreach meetings in the early 1990s, Heartbeat International leadership 447 Care Net and Heartbeat significantly retreated from describing these outreach efforts with the original campaign framing “Urban Initiatives.” Now Care Net refers to the project as its “Church Initiative,” saying that it is collaborating with churches in urban areas.

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discovered a troubling discrepancy: Boston and New York City had a number of abortion

providers but very few CPCs. After numerous meetings with CPC directors in each city,

Heartbeat created project REACH in 1999 in order to provide direct support to the poorly

coordinated and under-resourced centers in New York City.448 In addition to training

center volunteers in Heartbeat’s Volunteer Certification Program and funding

advertisements for the fourteen centers in the city, Project REACH got to work

developing “detailed maps showing abortion statistics by zip code to identify

neighborhoods in crisis and assist pregnancy centers in their expansion strategies.”449

Back at Heartbeat’s headquarters, the “Abortion Hub Study” was launched in

order to see if this expansion strategy could be applied nationwide. For every abortion

clinic they located, researchers calculated the distance to the nearest CPC, ultimately

assessing every state. The greater the distance between a center and an abortion clinic, the

more an area was determined to be “in need” of pro-life pregnancy resource services. The

study claimed to show that most abortion clinics were in major cities, while most crisis

pregnancy centers were located in the suburbs and rural areas.450 Furthermore, it

purportedly found that abortion clinics were located in predominately African American

and Latino immigrant neighborhoods.451 With the completed study supporting the initial

theory, Heartbeat brought the results to other leaders in the movement, including Care

448 Hartshorn, Peggy, Foot Soldiers Armed with Love, Donning Publishers Company, 2011, p. 66-70. 449 Pulse Newsletter, First Quarter, 2001, p. 1, Heartbeat International Records. 450 The study only used crisis pregnancy centers that had affiliate status with one of the nine organizations that signed onto the commitment of care. “Abortion Hub Research,” Aug 10, 2004, Heartbeat International Records. 451 I was not able to look at the raw data of the study, I only have records of the summary statement. The conclusions of the study are based on what Peggy Hartshorn, president of Heartbeat International, told me in our interview. Interview with Peggy Hartshorn, on file with Author, 12/12/12. Both the summary statement and Hartshorn’s book say that the results were shared with Heartbeat’s associates. “Abortion Hub Research,” Aug 10, 2004, Heartbeat International Records; Hartshorn Peggy, 2011, p. 71.

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Net and Focus on the Family. They agreed that center expansion should be directed

towards areas identified by the study. Failing to be located in areas where abortion

services were believed to be widely available exacerbated women’s vulnerability to

abortion, vulnerability that—according to the study—disproportionately impacted women

of color living in urban areas.

From this study, the “Urban Initiatives” and “Underserved Outreach” campaigns

were born. Care Net first set its sights on Atlanta, Georgia, while Heartbeat sent John

Ensor to Miami, Florida based on his success in expanding centers throughout the Boston

area during the 1990s.452 According to Heartbeat and its pilot project Heartbeat of Miami,

Florida was targeted because it showed up as one of four states with the highest rates of

abortion. When the study further determined that Miami had thirty-seven abortion

facilities, the city became Heartbeat’s testing grounds for the Urban Initiatives

campaign.453 The first center was established in Hialeah, one of the most conservative

cities in the country, with a predominately Catholic Cuban American population,

followed by a center in North Dade.454 Care Net began projects in Atlanta, Chicago,

Dallas, Houston, and Indianapolis, with Atlanta being subject to especially rapid growth

with four new centers opening in just three years.455

The campaigns launched by Care Net and Heartbeat and endorsed by Focus on

the Family have brought the most visible players of the alternatives to abortion

movement together with pro-life leaders of color, and as a result their narrative frames

have become connected as well. The success of developing centers in predominately 452 Hartshorn, Peggy, 2011, 72. 453 “Heartbeat of Miami,” http://www.heartbeatofmiami.org/about/#2. 454 Ranking based on a study conducted by the Bay Area Center for Voting Research in 2005. Hartshorn, 2011, 72. 455 CareNet Report, May/June, 2007, CareNet Report, Sept/Oct, 2007.

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Latino or African American urban areas depends in large part on the cooperation of local

churches. Growing the “third wave” of the pro-life movement—minority leaders

dedicated to the pro-life cause—has accompanied the goal of urban expansion in the CPC

movement. Organizations such as the Radiance Foundation, which sponsored the “Too

Many Aborted” campaign, draw on histories of slavery and eugenics to argue that

Planned Parenthood targets disproportionately targets Black women for abortion. The

CPC movement’s “Urban Initiatives” campaign offers a convenient solution to pro-life

race narratives.

In turn, tapping into arguments that abortion providers target African American

and Latina women has enabled the CPC movement to speak to racial inequality without

actually addressing socioeconomic factors that affect disparities in reproductive health as

well as maternal and child health outcomes. While many in the CPC movement and

broader pro-life movement attribute women’s continued use of abortion to a culture that

unduly pressures women into feeling like abortion is their only option, collaboration with

pro-life organizations of color has enabled CPC movement leadership to claim that this

cultural failing is greatest in communities of color. For example, the president of

Heartbeat International described the challenges facing women today as,

I would say that the challenges now to carry a baby to term are much greater than they were when AAI was founded. And that involves for one thing coercion towards abortion, women today because abortion is so common and so many people have had abortions and particularly in certain communities like the African American community, the rate of abortion is so high, you probably saw those numbers, they’re only 12 percent of the population and Hispanics are 12 percent of the population, Latinos, but they get 56 percent of all abortions. So in their own communities it is so common that there is almost an automatic tendency toward abortion and its [sic] just kind of the expected assumed choice. Um, and that maybe expected from the boyfriend, the father of child, the parents, the friends. I’ll just tell you one little story of a woman who

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worked for Care Net who is our sister organization an African American woman who was in charge of one of their programs. She told me one time she said she had had 2 or 3 abortions I forgotten [sic] how many but she came to healing she decided that those were terrible mistakes in her life she was working for Care Net, but she said you know I had never told anyone in my family that I had had those abortions so she said I sat down with my sister, she had three sisters, and my mother. She said I wanted to tell them this was a deep dark secret and she said you know when I did she said everyone just started crying weeping, everyone had had more than one abortion, her sisters and her mother so its [sic]so common in some communities that its almost the automatic choice.456

Here, Hartshorn uses a culture of poverty argument in order to racialize the “culture of

abortion” belief that drives the CPC movement. The adherence to this belief is so all

encompassing that Hartshorn fails to realize how the woman’s story of shame and

secrecy directly contradicts the supposed widespread culture of acceptance that allegedly

feeds abortion rates.457 A cultural explanation for abortion also ensures that the

movement need not address the role of structural inequalities in abortion, such as the fact

that finances are one of the most commonly cited reasons women obtain abortions. 458

While the CPC faction of the pro-life movement is not unique in its tendency to prioritize

culture over structure, it is significant because the bulk of what CPC volunteers do,

whether it is articulated by movement leadership or not, entails mitigating the effects of

structural inequality on their clients’ lives.459 While the movement’s appeals to abortion

456 Interview with Peggy Hartshorn on file with Author. 457 I am grateful to Elayne Oliphant for pointing out this contradiction. 458 Biggs et al., “Understanding Why Women Seek Abortions in the U.S.,” BMC Women’s Health, 2013, 13:29; Finer et al., “Reasons U.S. Women Have Abortions: Quantitative and Qualitative Perspective,” Perspectives on Sexual and Reproductive Health, Vol. 37, No. 3, Sept 2005. 459 For example, Hartshorn’s analysis that women are pressured into abortions by boyfriends, parents, and friends echoes the words of NRLC president Wanda Franz from 1991 that “having an abortion helps everybody but the woman,” quoted in Christian Science Monitor, Nov 25, 1991. My interviews with other executives affiliated with Heartbeat echoed Hartshorn’s response. My interview with President of International Life Services Sister Paula Vandegear, however, differed in that Sister Paula was more willing to speak directly about the socioeconomic status of her clients. When asked about the challenges women face she answered similarly to Hartshorn in citing the extreme pressure to abort from friends and family,

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rates and Planned Parenthood’s eugenicist agenda go a long way in obscuring this, the

majority of the women centers attempt to help are not seeking abortion services, but are

instead in need of pregnancy-related support.

If the CPC movement understands abortion through a cultural framework, then

the pro-choice movement understands it through a decidedly structural one. Pro-choice

campaigns against the CPC movement’s turn to pro-life race narratives summon the very

socioeconomic factors that pro-lifers refuse to acknowledge in order to accuse the

movement of targeting women who are the most vulnerable. A section of a NARAL

report on centers titled “Crisis Pregnancy Centers Target Low-Income Women and

Women of Color who are Most Vulnerable to the Lure of Free ‘Services’” argues,

This new focus is of particular concern when one considers that the rate of unplanned pregnancy among African American women, particularly among teens, far outpaces other groups. Further, African-American women are more than twice as likely to get late or no prenatal care as non-Latina white women, and are three times more likely to die from pregnancy related complications. These daunting statistics speak to the need for more reproductive-health information and resources in these communities, not a proliferation of fake clinics and anti-choice propaganda.460

NARAL draws upon a host of disparities in reproductive health outcomes for Black

women in order to illustrate their vulnerability. Yet concluding these statistics with the

assertion that CPCs are “anti-choice propaganda” makes it clear that these disparities are

listed to illustrate women’s lack of access to preventative services, leaving statistics about

prenatal care and maternal mortality seemingly out of place. The problem with invoking

but when it came to talking about service provision she was more willing to speak directly about the poverty of her organization’s clients. International Life Services offers an interesting counter example to Heartbeat and Care Net because Sister Paula has chosen to have a tighter hold on fewer affiliates instead of constantly working towards expansion like Heartbeat and Care Net and also appears to be less invested in appeasing critics of the movement. 460 NARAL, “The Truth about Crisis Pregnancy Centers,” Jan 1, 2014.

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rates of maternal mortality in a framework of prevention as a counter to accusations of

eugenics is that doing so runs the risk of confirming the accusations; preventing

pregnancy is the solution to poor maternal health outcomes disproportionately

experienced by Black women.

Perhaps even more important is the fact that the desire of NARAL and other pro-

choice organizations to capitalize on CPCs threat to choice ensures that they continue to

overlook just how much CPCs are failing to block access to abortion. This, in turn, means

that pro-choice organizations are also failing to address the women who do end up at

CPCs for pregnancy services. Given that the majority of women seek out centers for help

with carrying a pregnancy to term rather than for help obtaining an abortion,

understanding the barriers surrounding pregnancy-related care provides a more relevant

context with which to evaluate the role these centers play and starts to explain why

centers attract the women they do. As briefly mentioned in the NARAL report, racial

disparities in obstetrical outcomes and care persist in spite of major efforts to improve

key measures such as early initiation to prenatal care.461 Young women, Native American

women, African American women, and Latina women are more likely to receive late or

no prenatal care, while women with higher incomes and planned pregnancies are more

likely to initiate early access to prenatal care.462 Being uninsured also increases the odds

that women will receive late or no prenatal care, a factor more likely to affect low-income

461 For example, the Healthy People 2020 goal for early and adequate prenatal care is 77.6 percent, with 70.5 percent of women receiving this care in 2007. http://www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=26, Retrieved April 20, 2014. Allison Bryant et al., “Racial/Ethnic Disparities in Obstetrical Outcomes and Care: Prevalence and Determinants,” American Journal of Obstetrics and Gynecology, 202(4), April 2010. 462 Child Trends Data Bank, “Late or No Prenatal Care,” January 2014, http://www.childtrends.org/wp-content/uploads/2012/11/25_Prenatal_Care.pdf, Retrieved April 20, 2014.

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women dependent on Medicaid for insurance.463 Additionally, studies identifying

women’s perceived barriers reflect these findings, with women listing finances, lack of

childcare for existing children, lack of transportation, and uncertainty about the

pregnancy as issues that kept them from accessing care.464 Finally, at least one study has

shown that women using Medicaid or paying out of pocket are more likely to initiate

early prenatal care if prenatal clinics are in close proximity, a factor likely to

disproportionately affect women living in underserved areas.465

Given this admittedly abstract picture, it seems unsurprising that low-income and

poor pregnant women would turn up at centers offering “free pregnancy services.” There

is a significant need for such support. However, this support should not be tied to

inaccurate medical claims, conservative ideology, or conversion attempts. A framework

of choice misses the threat CPCs pose to poor and low-income women, many of whom

are increasingly women of color as a result of the movement’s recent expansion. The

threat is that a majority volunteer, faith-based conservative movement committed to

compulsory motherhood has become a major source of support for pregnant women and

mothers in need. More than a threat, this is the failure of a post-Roe society.

Philadelphia—Filling the Gaps

463 Additionally, the restrictions on cash assistance resulting from welfare reform legislation in 1996 may have decreased the number of women eligible for pre-pregnancy Medicaid insurance, making it more likely they would be delayed in accessing prenatal care despite becoming eligible as a result of pregnancy. Rosenberg et al., “Prenatal care initiation among very low-income women in the aftermath of welfare reform: does pre-pregnancy Medicaid coverage make a difference?,” Maternal and Child Health Journal, 11, 2007. 464 Julia Phillippi, “Women’s Perceptions of Access to Prenatal Care in the United States: A literature Review,” Journal of Midwifery and Women’s Health, Vol. 54, Issue 3, May-June 2009. 465 Sara McLafferty and Sue Grady, “Prenatal Care Need and Access: A GIS Analysis,” Journal of Medical Systems, Vol. 28, No. 3, June 2004.

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Much of the CPC movement’s success is a result of its effective rebranding and

strategic, abortion-centered campaigning. However, it is important to understand this

success in the context of changes to the structures of public aid available to mothers and

their children. It is significant that the CPC movement enjoyed its greatest expansion

during a period defined by the massive reordering of federal and state benefit programs.

These changes ensured that poor and low-income women with children would have even

less of a safety net with which to weather the realities of rising inequality. In this section,

I aim to show how CPCs took the place of that safety net by focusing on a single city and

state. In doing so, I approach CPCs from a framework of structural inequality rather than

a framework of choice in an effort to highlight barriers to access that negatively affect

maternal and child health outcomes. I argue that these barriers ensure the continued

relevance of CPCs and other pro-life service providers as necessary and limited resources

for pregnant women and mothers.

In Philadelphia, recent urban initiative efforts and the decades-long struggle with

infant mortality rates, racial and class inequality, and access to quality health care offer

an opportunity for a more grounded analysis of pro-life service provision and welfare

retrenchment. Additionally, the state’s unique history of funding alternatives to abortion

services reveals some of the cracks in the CPC movement’s most recent turn to urban

initiatives. One of the challenges of tracing welfare retrenchment is that it is difficult to

locate the state’s absence. Focusing primarily on Philadelphia, I try to visualize this

absence through a brief history of restructuring public aid, maternal and child health

outcomes, and the current landscape of public and private services.

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In the state of Pennsylvania, less than 2 percent of women received no prenatal

care in 2012, one of the main indicators of negative birth outcomes for both women and

their babies. Almost all mothers received at least one visit during their pregnancy.

However, a significant outlier belies this positive statistic. In Philadelphia Pennsylvania’s

largest county and one of the nation’s largest cities, nearly 6 percent of mothers received

no prenatal care prior to birth. From 2008 to 2010, infants born to women in Philadelphia

accounted for over half of all births in the state that received no prenatal care.466

Additionally, in 2010 Philadelphia had the lowest percentage of women who received

prenatal care in their first trimester, 52.8 percent compared to the statewide rate of 71.3

percent Given these numbers, it is unsurprising that Philadelphia’s average annual infant

mortality rate is 3 percent higher than the state’s, with a rate of 10.3 percent, 4 percent

higher than the national average.467 Philadelphia is also Pennsylvania’s poorest county by

far, with 25.6 percent of the population living below the poverty level, and ranks as one

of the poorest major cities in the United States.468 Nearly two-thirds of births in

Philadelphia are covered by Medicaid.469

These numbers are not distributed equally throughout the city, but

disproportionately affect Black women and their babies. Higher rates of preterm births

among Black women evidences the absence of accessible, quality prenatal care, and most

likely accounts for the fact that the risk of death before the first birthday is two to three

466 Tony Norwood, PA PRAMS Coordinator, Report: Prenatal Care, Pregnancy Risk Assessment Monitoring System, Sept 24, 2012, P 8-9. 467 Pennsylvania and County Health Profiles, 2013, Pennsylvania Department of Health, P 2 of Philadelphia County Profile. Joan Bloch, “Using Geographical Information Systems to Explore Disparities in Pre-Term Birth Rates Among Foreign-born and U.S.-born Black Mothers,” Journal of Obstetric, Gynecologic, and Neonatal Nursing, 40(5): 2011, p. 546. 468 Ibid, P 1 of Philadelphia County Profile. 469 McCool, William F. et al. “ ‘The Best Health Care Delivery System in the World’? Women’s Health and Maternity/newborn Care Trends in Philadelphia, PA, United States—1997-2011: A Case Report.”

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times greater for Black babies.470 Black women experiencing higher rates of preterm

births and higher rates of infant mortality as a result are also more likely to experience the

economic and violent effects of structural racism, as evidenced by the fact that rates of

preterm birth amongst black women are concentrated in the city’s poorest, most racially

segregated, most violent neighborhoods.471

The race and class distribution of infant mortality in Philadelphia has changed

little over the past three decades. Starting in the 1980s, high rates of infant mortality in

poor, Black neighborhoods of Philadelphia became one of the most devastating markers

of racial and class inequality afflicting the country’s major cities. As poverty, crack

cocaine, homelessness, and AIDS drew the nation’s attention to the plight of inner cities

towards the end of the 1980s, infant mortality rates amongst Black women living in urban

areas appeared to many as the starkest evidence of the nation’s refusal to provide its

citizens with the most basic services.472 Philadelphia became known for having one of the

highest rates of Black infant mortality in the country, with 22.4 deaths per 1,000 live

births in 1985; certain neighborhoods within the city reported even higher numbers.473

When the Bush Administration unveiled its highly criticized national program to address

470 Preterm birth and low birth weight are the leading causes of infant mortality. Bloch, 2011, p. 546. 471 Bloch, 2011. 472 In 1990, the Population Reference Bureau, Inc. published a report titled “Infant Mortality: An American Tragedy,” in which it argued that “elected officials are reluctant to declare a ‘War on Infant Death’” despite the United States’ position as “the most technologically advanced society on earth.” Christane B. Hale, “Infant Mortality: An American Tragedy,” Population Trends and Public Policy, Number 18, April 1990. 473 Russ, Valeria M. “Greater Expectations Bartram High Introduces Prenatal Program.” Philadelphia Daily News. Nov. 4 1987. In North Philadelphia the infant mortality was 30.5 deaths per 1,000 live births in 1990. See Sicism, Leslie. “A Neighborhood Struggles for a Revival.” New York Times. Nov 18, 1990.

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infant mortality in 1991, Healthy Start, West and South West Philadelphia were among

the fifteen original demonstration sites to receive funds.474

During this same period, CPCs and other pro-life services such as maternity

homes, Catholic Social Services, and Catholic Charities in the state of Pennsylvania grew

from 92 operations in 1983 to 150 operations in 1989.475 This growth was in stark

contrast to other programs focused on services for the poor, which struggled to stay afloat

in the aftermath of Ronald Reagan’s 1981 Omnibus Budget Reconciliation Act. The

movement’s volunteer, donation-based livelihood enabled CPCs to go practically

untouched by the new federalism.476 As community health centers and non-profits felt the

squeeze of decreased federal revenue combined with increased demand due to the

restructuring of AFDC eligibility requirements and cuts to grants in aid for state and local

governments, the network for pro-life service providers expanded. CPCs were one of the

few non-profit operations that fulfilled Regan’s desire to “unleash the independent spirit

of the people and their communities” in order to use volunteerism “to give the

government back to the people.”477

474 The program was considered by many to be an empty gesture due to the fact that it relied on funds originally allocated to community health centers and the Maternal and Child Health Services Block Grant, in effect taking money from programs already serving poor pregnant women. See Robert Pear, “Bush Plans to Fight Infant Deaths Would Use Money Going to Poor,” NYT Feb 7, 1991, A1. For more on Philadelphia sites see Collins, Huntly. “From Healthy Start, Mixed Results/It Helps the Poor. But in Parts of Phila., Babies Still Die in Large Numbers.” Philadelphia Inquirer. Dec 23, 1997, A1. Programs funded by Healthy Start have since expanded to North, Northwest, and South Philadelphia. National Healthy Start Association. 2011. “Saving our Nation’s Babies: The Impact of the Federal Healthy Start Initiative,” p. 50, http://www.nationalhealthystart.org/site/assets/docs/NHSA_SavingBabiesPub_2ndED.pdf. 475 AAI Worldwide Directories, 1983, 1989, Heartbeat International Internal Records. 476 “Nonprofit Organizations: the Lost Opportunity,” Salamon, Lester M. in The Reagan Record ed by John L. Palmer and Isabel V. Sawhill, Ballinger Publishing Company, Cambridge MA, 1984. 477 For an overview of the areas hardest hit by the Reagan Administration’s budget see Richard P. Nathan, Fred C. Doolittle, and Associates, Reagan and the States, Princeton University Press, 1987, Ch. 3. For a discussion of how these cuts affected community health clinics, especially women’s health organizations, see Sandra Morgen, Into Our Own Hands, Rutgers University Press, 2002, Ch. 8. Reagan quote from “Nonprofit Organizations: the Lost Opportunity,” Salamon, Lester M. in The Reagan Record ed by John L. Palmer and Isabel V. Sawhill, Ballinger Publishing Company, Cambridge MA, 1984.

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In addition to heightened attention to infant mortality in the city and the growing

presence of pro-life services, Pennsylvania was gaining attention for Governor Robert P.

Casey’s efforts to curb abortion access. Casey is perhaps most well known for signing the

1989 Abortion Control Act into law and defending it up to the 1992 Supreme Court case

Casey v. Planned Parenthood, a decision that both empowered states to place restrictions

on abortion services and reaffirmed Roe. However, Casey also made Pennsylvania the

first state to allocate public funds to pro-life services, a move most likely overshadowed

by the high-profile Supreme Court case. While a portion of the state budget went to the

newly created alternatives to abortion program for the first time in the early 1990s, it was

not until 1996 that Pennsylvania launched Program Women in Need, funneling two

million dollars of the state budget towards alternatives to abortion services that included

CPCs as well as social service agencies, adoption services, and maternity homes.478 In

2002, Pennsylvania had another first, directing a million dollars of TANF federal funds to

alternatives to abortion services that were not limited solely to abstinence education.479

While the state invested in alternatives to abortion throughout the 1990s and

2000s, the city of Philadelphia underwent changes that adversely affected maternal and

child health outcomes in spite of the multiple Healthy Start sites. Beginning in 1997,

hospitals in various parts of the city closed down their obstetric units due to rising

insurance premiums for providers and low reimbursement of maternity care services. By

478 Vitoria Lin and Cynthia Dailard, “Crisis Pregnancy Centers Seek to Increase Political Clout, Secure Government Subsidy,” The Guttmacher Report on Public Policy, No. 2, 2002, p. 5. 479 Under welfare reform, federal funds became available for abstinence education and many CPCs’ expanded services to include educational outreach to schools. When critics of centers argue that they are federally funded, this is most often the funding they are referring to. PA’s program is unique in that it directs state funds directly to services provided as opposed to being earmarked only for abstinence only education. “Temporary Assistance for Needy Families,” State Plan Submitted by the Pennsylvania Department of Public Welfare, n.d., p. 13-14; http://www.realalternatives.org/PressKit/History.htm, retrieved April 17, 2014.

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2011, the city went from nineteen to six available maternity wards. Five of the eliminated

wards had offered midwifery services.480 The shift to Medicaid -managed care that

started slowly in the mid-1980s and was embraced in full throughout the 1990s most

likely also affected Philadelphia’s “maternity care crisis,” which was disproportionately

experienced by poor, Black women.481 The Philadelphia-based advocacy organization

Maternity Care Coalition (MCC) corroborated research that found recipients of Medicaid

managed care have less access to prenatal care; in 2007 and 2011 MCC found that the

five Medicaid managed care organizations serving the city were plagued by inaccurate

listings, prolonged wait times, and disproportionate geographic distribution, barriers to

prenatal care that only women on Medicaid faced.482 The continued lack of accessible

prenatal and childbirth care has prompted advocacy work dedicated to reinstating some of

the infrastructure lost as a result of numerous past changes to healthcare delivery in

Philadelphia.483

This structural context allows for a more thorough understanding of the role pro-

life services have played in Philadelphia. At first glance, the trajectory of CPC

development in the city since the early 1970s reflects a familiar pattern, one that has been

480 McCool, William F. et al. “ ‘The Best Health Care Delivery System in the World’? Women’s Health and Maternity/newborn Care Trends in Philadelphia, PA, United States—1997-2011: A Case Report.” Midwifery 29 (2013): 1158-1165 (cit. 1159). 481 For an overview of Philadelphia’s shift to Medicaid managed care see Maskovsky, Jeff. “‘Managing’ the Poor: Neoliberalism, Medicaid HMOs and the Triumph of Consumerism among the Poor.” Medical Anthropology 19, 2010: 121-146. Coverage through Medicaid managed care has been shown to negatively impact quality of care generally, including neonatal outcomes for preterm babies, see Brandon, Gwieneverea D. et al. “Are Outcomes and Care Processes for Preterm Neonates Influenced by Insurance Status?” Pediatrics 124, 2009: 122-127. 482 Maternity Care Coalition. “Survey of Prenatal Care Availability for Medicaid Managed Care Recipients.” 2011. 483 Womencare was formed in 2009 in response to hospitals located in Northeast Philadelphia closing down the labor and delivery units. The major goal of this non-profit is to establish a Federally Qualified Health Center focused on women’s and maternal health, a goal that can be read as trying to undo the effects of disinvestment and restructuring of public healthcare that has occurred over the past three decades. http://womencarepa.org/about-us/history/.

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narrated by leaders of the CPC movement as the three waves of alternatives to abortion

activism.484 The first center was founded prior to Roe by the Catholic organization

Birthright. It was located in a majority white Catholic area of the city. In the early 1980s,

Alpha Pregnancy Services was established in the city center, reflecting the common

strategy of not signaling that the clinic was pro-life and choosing a name that would

allow it to be listed under “Abortion” in the phone book. By the late 1990s, Choices

Pregnancy Options Center became the city’s first CPC to also be a licensed medical

clinic, reflecting the widespread influence of NIFLA’s efforts to protect centers against

suits by helping them transition to legal medical clinics.485 Finally, Care Net was able to

list Philadelphia as one of its “underserved area” success stories in 2008. In addition to

being owned and run by the Black Greater Exodus Baptist Church, Hope Center is

located in the predominately black and poor area of North Philadelphia.486 Housed in one

of many buildings owned by the church, the center is only the most recent project of the

church’s non-profit operation People for People Inc. Counselors are just as likely to steer

women who visit the center to the organization’s welfare-to-work Employment and

484 The three waves narrative begins with the Catholic response before and immediately following Roe, the Evangelical response in the early 1980s, and the influx of minority leadership in the early 2000s. Interview with Peggy Hartshorn, on file with author. See also Foot Soldiers Armed with Love, p. 58-59. 485 Being able to advertise as medical clinics was an important part of the movement’s rebranding efforts of the 1990s and NIFLA, Care Net, and Heartbeat aggressively promoted centers transitioning to licensed medical clinics. Focus on the Family’s “Operation Ultrasound” has provided funds to ensure centers are able to obtain ultrasound machines, the main motivation for obtaining medical status aside from legal protection. This feature of the movement’s development has been important for its growth, and will most likely continue to be so as more states pass laws requiring women to obtain ultrasounds at crisis pregnancy centers before obtaining an abortion. It might make sense to include this development in future versions of the chapter. 486 With financial support from Care Net’s donors, Hope Center opened in 2008. Care Net Report, Nov/Dec 2007, https://www.care-net.org/uploads/report_date/NovDecCNR.pdf.

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Retention Network Center as they are to inform them that “all you have to do is have

proof of pregnancy and you go to the local welfare office.”487

These are the city’s four CPCs, illustrating the movement’s observation that

centers are concentrated in suburban and rural areas. Yet it would be inaccurate to

conclude that pro-life service provision has a relatively small presence in the city,

particularly in low-income and poor neighborhoods of color. The network of pro-life

service provision is actually far more robust than the four stand-alone CPCs located in

various Philadelphia neighborhoods (See Fig. 1). Seven Catholic Social Services centers,

four CORA sites—a Catholic organization dedicated to children and families in need—

two maternity homes dedicated to homeless women and their children, and an adoption

agency that offers pregnancy counseling, together with the CPCs comprise a network of

services. Many of these agencies receive funds from the state’s alternatives to abortion

program.488 Far from operating only within the bounds of this pro-life network, these

agencies have established relationships with other organizations serving the population of

pregnant women and children, and it is not uncommon for service referrals to go both

ways.489 In addition to the CPCs, these pro-life service agencies have linked with public

and non-profit programs to fill the gaps in support for women and children, evidenced in

part by the fact that many of the pro-life service agencies are serving some of the poorest,

487 Armstrong, Jenice. Philadelphia Daily News. Jan 25, 2011. 488 All of the Catholic Charities in Philadelphia are listed on the Real Alternatives website as funded providers. Real Alternatives is the contracting agency that distributes state funds to individual centers and programs. Importantly, none of the CPCs are on the Real Alternatives website. I suspect they do not qualify for funding because eligible providers must agree not promote religious teachings in conjunction with providing services, but I have not been able to speak with anyone at Real Alternatives to confirm this. 489 My conversation with an employee at Maternity Care Coalition (an organization that identifies as pro-choice and provides both abortion and contraception counseling and referrals) about the relationship between MCC and crisis pregnancy centers and other pro-life social services confirmed for Philadelphia and the surrounding counties of Delaware and Montgomery what Kimberly Kelly found in her ethnography of centers. Centers do not shy away from partnerships with other organizations or from helping women obtain publicly available aid and support. See Kimberly Kelly, 210-213.

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Blackest parts of the city (See Figures 2 and 3). These gaps are felt most intensely by

women without the necessary resources to privately fund the costs of pregnancy and

motherhood.

Figure 1

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Figure 2

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Figure 3

How are we to evaluate this network of public and private, secular and religious

service providers dedicated to women and children? On the one hand, the fact that pro-

life services have become enmeshed in the chain of support for mothers and children in

Philadelphia’s most underserved neighborhoods speaks to their necessity, that they are a

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needed community resource. On the other hand, the conservative vision of women’s

reproductive and sexual autonomy that guides pro-life service provision evidences the

insufficiencies of this patchwork of services. It reveals the need for comprehensive

reproductive services that conceptualize family planning, abortion, pregnancy, and

childbirth as a spectrum of reproductive experiences that should not placed in opposition

to one another. Perhaps most importantly, it provides evidence of what happens when

pregnancy and motherhood are abandoned as public goods, leaving the women who are

unable to manage the realities of reproduction privately and independently vulnerable to

charitable intervention that may or may not have a holistic vision of reproductive health

and autonomy.

Conclusion A 2004 report published by Care Net showed that of the more than 110,000

women who visited Care Net affiliates that year, 90 percent of them carried their

pregnancies to term. While applauding the results of Care Net’s venture into producing

statistical reports on its affiliate operations, former President Melinda Delahoyde offered

a caveat. “These are encouraging statistics; however, a majority of the women who are

currently visiting pregnancy centers are likely to carry their babies to term, but need

resources and emotional support that may not be found elsewhere in the

community. While this is a valuable service, pregnancy centers want the majority of

women who visit their centers to be those who are actually considering, or at risk of,

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having an abortion. Analysis of annual statistics helps Care Net know what is needed to

help pregnancy centers better reach the population most at risk.”490

Since 1971, the CPC movement has understood its primary purpose to be

combating abortion through service provision to pregnant women in need. Yet only a

decade into its existence, the movement was confronted with a problem that continues to

challenge its sense of purpose—pregnant women in need are not necessarily the same

pregnant women seeking an abortion. As a result, the movement has struggled with the

fact that preventing abortion by providing pregnancy services free of charge is a strategy

that necessarily confronts the dearth of medical, material, and social support available to

poor and low-income women, many of whom are women of color.

This struggle has only grown more difficult as supports for pregnant women and

mothers have decreased. Yet I have argued that it is this very disinvestment that keeps the

movement relevant despite its failure to block women’s access to abortion. The

movement has benefited from the space created by disinvestment in programs for the

poor, the restructuring of healthcare services, and a greater reliance on private charities to

play the service role once considered the responsibility of the state. These gaps ensured

that some of the services and material support offered by CPCs remained in demand even

as the population in need was not the one volunteers and leaders in the movement had

initially set out to help. By advertising free pregnancy services and support, centers may

even be among the most accessible service providers within this under-resourced network

because they do not have to divide their resources or attention; they speak directly to poor

and low-income pregnant women. 490 Melinda Delahoyde and Kristen Hansen, “Pregnancy Centers: A Practical Response to the Abortion Dilemma,” The Religion and Society Report, Vol. 23, No 3.

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Given Delahoyde’s tempered enthusiasm about the thousands of women CPCs

aided, one should be skeptical about whether CPC volunteers are in fact best positioned

to serve pregnant women. Rather, we should see CPCs’ advocacy of pregnant women and

mothers—a mere side effect of a failed pro-life tactic—as an indication of just how much

we are willing to invest in pregnancy and motherhood as a shared cost and reward of life.

CPCs are the outcome of a society that has decided this is a private, individual cost.

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CONCLUSION

During the lead-up to the 2012 presidential election, Democrats, journalists, and

reproductive rights activists reinvigorated the charge that Republicans had declared a

“war on women.” The unprecedented number of abortion restrictions introduced at the

state level in 2011 and Congressional debates over the contraceptive mandate in the

Affordable Care Act put women’s reproduction at the center of party politics.

Conservative, male Republicans were eager to make their opinions on abortion, birth

control, and women’s bodies known. Their uninspired misogyny, most famously

represented by Todd Akin’s “legitimate rape” comment and Rush Limbaugh’s slut

shaming of Sandra Fluke, lent credence to the hyperbolic phrase. Women responded

online and on the ground, protesting Virginia’s mandatory ultrasound bill with

accusations of “transvaginal rape,” shaming the Susan G. Komen foundation for freezing

funds to Planned Parenthood, and mobilizing such overwhelming support for Fluke that

several of Limbaugh’s sponsors dropped him. In the wake of the Obama administration’s

reelection, Gallup reported the largest gender gap of any presidential election, with

twenty points between Mitt Romney and Barack Obama.

While there was ultimately little uncertainty amongst female voters as to which

party had declared a “war on women,” Republicans did their best to turn the tables with

CNN political commentator Hilary Rosen’s gaffe that stay at home mom Ann Romney

had “never worked a day in her life.” The Obama administration immediately put

distance between itself and Rosen by acknowledging that not only was motherhood a job,

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but it was actually the hardest job of all. Despite these efforts, Republicans used the

comment to garner a foothold in the “war on women” strategy and depict the Obama

administration as anti-family. Meanwhile, journalists were eager to declare the return of

the “mommy wars,” pitting stay-at-home moms who sacrifice their careers against

working moms who sacrifice their children’s upbringing.

These two prominent moments in the lead-up to the presidential election illustrate

the dominant ways we understand women’s reproduction in a post-Roe era. While the

ability to limit reproduction is thoroughly associated with choice and a broader agenda of

women’s rights, the ability to mother is confined to the private realm of the family at the

same time that it is culturally revered as “work.” These frameworks were so politically

powerful because they are foregone conclusions in a post-Roe landscape. Despite

Romney’s advisors’ best attempts to use Rosen’s statement against his opponent,

Democrats and Obama were more than happy to agree that the family and motherhood

should remain off limits, legislatively as much as rhetorically. Republicans bent on

constraining women’s choice and ushering in a return to unbridled misogyny posed the

only true challenge to these entrenched frames. Their retrograde efforts and the

subsequent outcry on the part of pro-choice activists provided cover for the fact that these

two frames work together to constrain all women’s reproductive freedom while most

severely limiting it for poor women, young women, and women of color.

Reconceived explores battles over reproduction that entailed questioning and

ultimately rejecting these frameworks. In their varied ways, advocates refused to see

women’s reproduction, especially pregnancy and motherhood, as a burden that might be

resolved through choice on the one hand or the privatization of motherhood on the other.

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They also refused to see the realities of pregnancy and motherhood as somehow distinct

from other political battles that directly affected women’s lives.

Reconceived has focused its energies on the spaces where pregnancy and

motherhood bumped up against political agendas and institutions that had no interest in

the ways reproduction intersected with poverty, racism, disease, and incarceration.

Despite advocates’ efforts, by and large these conflicts typically resulted in further

relegating reproduction to the private realm of individual responsibility rather than the

public realm of liberal citizenship. But understanding these outcomes is important for a

politics of reproductive freedom that is equipped to respond to reproductive neglect just

as equally as punitive regulation. Indeed, the “war on women” was galvanizing not only

because of the draconian content of proposed legislation but because of the explicit

hostility contained in conservative male Republicans’ discussions of the proposals.

Efforts to limit abortion and birth control access were direct and intentional moves to

regulate women’s bodies.

The problem is, as Reconceived has shown, not all barriers to reproductive

freedom take this form. In 2014, a report released by reproductive justice organizations

highlighted the poor reproductive health outcomes for Black and Latina women in the

United States, specifically Black women living in southern states and Latinas living in

south Texas.491 The report mirrored the findings of a 2010 report from Amnesty

International that highlighted the increasing rates of maternal mortality for Black women

491 “Reproductive Injustice: Racial and Gender Discrimination in U.S. Health Care,” Center for Reproductive Rights, National Latina Institute for Reproductive Health, SisterSong Women of Color Reproductive Justice Collective, 2014.

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in the United States492 The combination of poverty, lack of health insurance, and racial

discrimination on the part of health providers were highlighted as the major causes of the

devastating health disparities covered in the report. These reports, while receiving little

coverage and inciting little outrage, illustrate the ways broad structures of inequality

interact with explicitly hostile violations to constrain women’s experiences of

reproduction. Poverty, privatized healthcare, structural racism and sexism, and the

capitalist necessity of keeping reproductive labor valueless also constrain reproductive

freedom, but often from a distance that can make their precise effects hard to pin down.

By focusing on battles over institutional supports for pregnancy and motherhood,

Reconceived foregrounds this backdrop of reproductive neglect that makes possible more

targeted reproductive rights abuses. It explores how a framework of choice obscured this

backdrop in a number of the battles examined here. Ultimately, Reconceived argues that

we must make visible the ways reproduction is disavowed and elided just as often as it is

controlled if we are to truly understand what keeps reproductive freedom out of reach.

492 “Deadly Delivery: The Maternal Health Care Crisis in the USA Summary,” Amnesty International, March 2010.

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