Book Review - Dangerous Pregnancies: Mothers, Disabilities, and Abortion in Modern America

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Publication Date: 
Wed, 2013-02-06

BOOK REVIEW

Dangerous Pregnancies: Mothers, Disabilities, and Abortion in Modern America by Leslie J. Reagan. University of California Press, 2012 (paperback).

Review by Abby Lippman

Rubella—the viral infection that made for "Dangerous Pregnancies"—is the central pivot for this book, with many other important women’s health issues playing strong supporting roles. These include abortion, the preventive uses of biomedicine (including the role and safety of vaccines), and the roles of women as guardians of the health of their children, as well as the multiple and overlapping intersections of these with eugenics, racism, and classism. The author, Leslie J. Reagan, addresses all of these issues and intersections in themselves and as kinds of proxies for ongoing political and social debates of the 1960s and 1970s in particular. She pulls many different strands together and her weaving is varyingly successful. 

With 87 pages of notes and a 21-page bibliography, this book would seem to self-identify as more for academics than for general readers. However, while it is rich in details and diligently referenced, not all the notes and citations need to be read; anyone curious about or interested in one or more of the various threads that run through its pages will likely find some special insights and details worthy of reflection.

The major threads Reagan presents track how the disease (rubella, also known as German measles) was discovered; how responses to rubella, and fears of it, resonated in the efforts to make abortion legal and accessible in the United States; how class, race, and privilege all played roles in abortion access; how disability activism and eugenics were mobilized to promote vaccinations and abortions; how vaccines and vaccination programs got adopted; and how these all cross link.

This look back to the second half of the 20th century is worth recalling since current attention to various efforts to limit women's rights to abortion (e.g., private members' bills in Canada, state legislation in the United States) make the book's historical perspective on matters surrounding this procedure and its availability and legality timely reminders and warnings of how fragile women's rights for choice remain. Similarly, the history of rubella vaccine development and use is often echoed in today's ongoing discussions about safety of the current vaccine given to infants to prevent rubella (the triple MMR) that addresses measles, mumps and rubella) as well as in debates surrounding vaccinations for HPV infections.

This book may have special interest for me because I lived what is now merely history for most. I grew up in an age of "rubella parties"—not a referenced term but definitely mentioned in the book. When one child in the neighborhood developed rubella, my mother and other parents would take their daughters to visit to ensure we were exposed, knowing that childhood illness would protect us later in life against an infection during pregnancy when harm could be done to the fetus. Then, as an adult, I worked on a longitudinal study in the 1960s of the behavioral effects of congenital rubella (that eventually led to a book cited by Reagan: Stella Chess, Sam J. Korn & Paulina B. Fernandez. Psychiatric Disorders of Children with Congenital Rubella, New York: Brunner/Mazel, 1971). And perhaps most relevant: I was "there" in the United States in the pre-Roe v. Wade years when abortion was illegal and battles to change this were preoccupations for feminists.

But younger women will find lots of interest here, too, because in many ways, Dangerous Pregnancies is as much (maybe even more) about abortion and access to it as about rubella, with an infection of a woman used as a lens for exploring gatekeeping, access, and attitudes to women's choices—issues of persisting relevance.

Reagan handles this material well, and throughout shows the links clearly and persuasively. For example, in Chapter 3 she portrays women as "moral pioneers" with regard to abortion, and "legal pioneers" insofar as they brought issues of "wrongful birth" to public attention. There is much detailed legal analysis in these pages, with archived legal records under scrutiny. However, this material can be hard going even for the reader in the Unites States where this pertains; it's not obvious that the average Canadian reader will really care. And while Reagan's portrayal of the racism of the law is good, this (racism) could be about any procedure proposed for black women—and not only "induced abortion" because of rubella.

Reagan also covers vaccines and vaccination programs rather well. What seems most striking to me in reading her history is realizing how a vaccine (rubella), which she emphasizes was first warmly embraced, has recently  come to be seen by some as an  "enemy," and where  the goal was once to seek its protection from rubella and the congenital rubella syndrome, this product is now seen by some as a vaccine to avoid and condemn because of lingering allegations it is a cause of autism. (A change in perspective that will perhaps itself be the basis of some future book!)

Reading even recent histories about women's health issues is fascinating for how much it reveals about what has, and more often, what hasn't really changed over time. Thus, another insight from this book is how, early on, vaccination campaigns focused on the desires of women to protect their health and that of their babies only later to be transformed, "ahistorically" Reagan suggests, into efforts to make women responsible for harms to their children: their poor behaviors were to be viewed as threats to children's health and well-being instead of the true risks created by  the external conditions of their lives—with this culminating in attempts (in Canada as in the United States) to criminalize pregnant women who do not behave "properly."

According to Reagan, rubella "marked bodies and then marked society." This is a broad claim and although she offers much evidence to support it, her insistence on it is not always convincing. Perhaps the many threads she is trying to connect directly just don't blend sufficiently so that some of this seems forced. Thus, despite her vast knowledge of the social history of the times she writes about (mainly the 1960s), too often Reagan inserts this material casually when her focus is elsewhere and this can disrupt her own story line. For example, in the middle of a discussion of blood tests for rubella, with its biomedical context only coming about two paragraphs later, she refers to events in Berkeley (California) and Selma (Alabama) that may be interesting but aren't really needed here. 

Similarly, the archival/historical research in Chapter 4 ("law making and law breaking in an epidemic") may also be overwhelming for the general reader, the importance of the points about how the political debates about abortion were fueled by the rubella epidemic notwithstanding.

Rubella is no longer the scourge it was in North America, and this is likely due to the efforts of women over the years first to clarify its nature as a distinct disease (mainly by comparing their experiences that led to recognition that a generally mild infection of a pregnant adult could lead to serious problems in children born subsequently) and then to make abortion "respectable" insofar as having rubella during pregnancy became an accepted indication for what was then called a "legal" (or "therapeutic") abortion. Unfortunately, by framing children with congenital rubella syndrome as unwanted or undesirable—rather than in need of social and medical services to which they were entitled— this framing likely paved the way for what was to become generally uncontested offers of and requests for abortion  when women began routinely to undergo routine prenatal tests for such conditions as Down syndrome: the normalization of abortions for "fetal abnormalities" detected in utero was underway. As was the view of children with disabilities as objects of pity or worse.

Despite all that has changed since the 1960s to make pregnancy less dangerous for many women and children, the benefits are not equitably distributed today. Choices to become or to avoid pregnancy, to control the number of children one has, to be able to raise the children one wants in conditions of safety and security all remain elusive for too many. So even if the dangers of rubella need not be the biggest concerns of women in Canada (and the United States), we still have far to go to achieve reproductive justice and to proclaim reproduction and motherhood as safe for all.

 

Abby Lippman is a longtime feminist activist with special interests in women's health and women's health policies. Also an academic based at McGill University and passionate about writing, Abby is past president of the CWHN, and is now on the board of the FQPN where she works closely with them in building an inclusive reproductive justice movement in Québec.