Beyond Choice

Reproductive Freedom In The 21st Century


By Alexander Sanger

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Thirty years after Roe v. Wade, the argument between “pro-choicers” and “pro-lifers” has reached stalemate. Pro-choice arguments haven’t persuaded a comfortable majority that legal abortion is vital to our society, nor addressed our moral qualms. Younger people are less and less supportive of reproductive rights. Since 1996, state legislatures have enacted nearly 300 pieces of anti-choice legislation. With Roe in jeopardy, International Planned Parenthood Council Chair Alexander Sanger asks a simple but heretical question: How many more pieces of anti-choice legislation will it take to get the pro-choice movement to rethink its approach to the issue?

In Beyond Choice Sanger explores the history of the reproductive rights movement to discover how it got stuck in its thinking, and then provides a convincing new argument for the moral rightness of its cause. He shows why it is vital to the health and survival of the human race that couples be able to have children, or not, when they choose; why reproductive rights are just as important to men as to women; and why, in an era of new reproductive technologies, completely unfettered choice is not morally defensible.

Beyond Choice is inspiring and important reading for women’s rights advocates, opinion leaders, medical ethicists, and anyone concerned to preserve our freedom to reproduce, or not, without government intervention.


To my wife, Jeannette,
My Three Boys,
Ralph, Andrew, and Matthew,
With All My Love

My wife, Jeannette, and I have raised three boys. When Jeannette was about four months pregnant with our middle son, Andrew, we went to her doctor for a checkup and a sonogram. We had difficulty reading the screen, but the doctor assured us everything appeared normal. The doctor asked if we had any history of genetic diseases. My wife volunteered, "I have congenital hip displaysia. At age 30 I had bone transplant surgery to try to correct the problem."
The doctor—this was in 1981—leaned forward and said, "In a few years there is going to be a genetic test to determine early in a pregnancy if the fetus carries that defective gene."
Jeannette looked at the doctor and said quite firmly, "I would never kill my baby because he had hip displaysia."
As we walked outside the hospital Jeannette and I reflected on the conversation. While acknowledging that abortion ought to be legal, Jeannette said she did not know if she could ever have an abortion for any reason. Having an abortion seemed somehow "wrong." "I don't think I could ever have one."
My wife's opinion puts her squarely in the middle of America's broad range of public opinion on abortion. She simultaneously thinks that abortion should be legal and that it is in many cases wrong. She is pro-choice, mostly.
The mostly pro-choice American public acquiesces in and supports an increasing number of restrictions on access to abortion. Most Americans favor government regulations that officially discourage abortion and that make abortion difficult to access and available only to women who can pay for it on their own in private clinics. In this view abortion should be legal but available only after the woman surmounts some significant obstacles to get one. In contrast to this "centrist" position the pro-choice camp advocates that abortion be accessible and available whenever and wherever a woman decides to have one, and the pro-life camp advocates that abortion be re-criminalized. These two opposing points of view represent the stark choice that America faces—abortion can either be legal or illegal. In fact, it has been both at different times throughout our history. At this moment in America it is a little bit of both—technically legal but difficult for many to access.
I will argue in this book that this current state of affairs is wrong and that it is better for women, and for men and children too, that abortion be fully legal and accessible. I will argue that having abortion legal and accessible is morally right, not morally wrong. I will provide a framework for analyzing whether some decisions about childbearing and abortion are morally wrong and therefore should be prohibited by law.

The Pro-Choice Versus Pro-Life Debate

What does it mean to be pro-choice? Being pro-choice means being in favor of allowing women to make up their own mind about whether or not to have a child. It means that a woman should have this power both before and after she is pregnant. She should have the choice in the first instance to become pregnant or not, and, if she is pregnant, she should have the choice not to be, that is to say, to have an abortion and terminate the pregnancy. Being pro-choice means being in favor of contraception's and abortion's being legal, available, and accessible to those who want to use them, no matter what their personal circumstances might be and what decision they want to make. Being pro-choice means believing that the government has the obligation to ensure that all its citizens have access to the health care they need, including birth control and abortion, both of which should be covered by insurance or Medicaid as a matter of public health and fairness. Being pro-choice means that decisions about childbearing are for the woman to make, not for other people or the government.
Until the middle of the twentieth century in America it was a matter of great controversy whether or not the use of contraception was moral. It is now generally accepted by most people, except the hierarchy of the Roman Catholic Church and some others, that contraceptive use is moral. The moral objection to the pro-choice position is now mostly centered on abortion. Opponents of legal abortion consider abortion the equivalent of murder. Life begins at conception, they say, and the human embryo or fetus is an innocent human being and is entitled to be born. Abortion is an act of violence that kills a baby who cannot protect or defend itself. In this view, an absolute moral standard that respects and protects life, sometimes expressed in religious terms and sometimes not, should overcome both the right of individuals to make personal choices about childbearing and the personal hardship that may result from having an unwanted child.
Opponents of legal abortion, and even some supporters of legal abortion, have additional concerns—they do not like the use that some people make of legal abortion, they do not like the decisions that are being made, and they do not like the social consequences of having abortion being legal. Opponents of legal abortion believe that abortion is used, wrongly, as a form of birth control. As they describe it, abortion permits lifestyle choices of which they disapprove. In their view legal abortion, like birth control, makes it easier to have sexual intercourse outside of marriage and contributes to the weakening of the moral fabric of society. Abortion opponents argue that legal abortion makes the non-use of birth control more likely and indirectly contributes to the rise in sexually transmitted diseases, unintended pregnancy, and abortion itself. Life is unfair, they say, and an unwanted pregnancy is another of life's challenges and vicissitudes that should not be dealt with by killing an unborn child. They argue that life is cheapened by legal abortion and that civilized society is the worse for it. The opponents of legal abortion range from those who are discomfited by it to those who are outraged by it. Underlying the views of some abortion opponents is the traditional view of women as mothers and caregivers of children. In this view liberating women from these roles through legalizing abortion is not beneficial for society.
Those of us who favor abortion's being legal counter these arguments with four basic arguments.
First, we argue that a woman has the right to use birth control and have an abortion because the pregnancy affects her body and her body only. A woman has the right to control what she does with her body and what happens to it. No woman should be forced to have a child if she does not want to. Having a child is a fundamental life-altering decision, and it is for the woman to make this decision. It is irrelevant if she is pregnant or not at the time she chooses to make this decision.
Second, we argue that as a general rule American citizens are entitled to live their private lives without unnecessary government interference. Our right to privacy includes such decisions as where to live, what to do for a living, whom to marry, and whether to have children and how we raise them.
Third, we argue that it is better for women's health if birth control and abortion are legal, safe, and regulated, rather than illegal, unsafe, and unregulated. History has shown that women will use these services even if illegal and clandestine, and illegal medical services of any kind are a danger to women's health and lives.
Finally, we argue that families and society will benefit from parents having children that are planned, welcomed, and properly spaced. Every child should be a wanted child.
These arguments for and against abortion's being legal, moral, and acceptable have been made in one form or another for the past thirty years since Roe v. Wade was decided in 1973. Advocates on each side, and I was and am one for the pro-choice side, have attacked each other's positions in a debate more noted for absolutism and acrimony than civility and reason. Despite this vociferous public debate, by and large the position of the American people on abortion has not changed in the last thirty years. There are even some indications that the American public is slowly gravitating more to the anti-abortion side than the pro-choice side. This is personally depressing. What have I been doing wrong for the past decades? Why have my pro-choice arguments not been persuasive?
I think there are four reasons. First, the arguments based on women's rights and on a woman's right to control her body are addressed primarily to women. These arguments do not directly address the reproductive interests of men, except indirectly under the altruistic assumption that men should be concerned with the well-being of their wives, girlfriends, sisters, daughters, and fellow humans of the opposite sex. These arguments ignore the reality that men have their own reproductive interests and that men want to have children when they want to have them. These interests are not addressed by arguments based on women's rights.
In addition, any argument based on a right to bodily autonomy must recognize that there are exceptions to this rule and that it cannot be absolute. For over a century public health authorities have been able to require vaccinations against infectious diseases, even if the vaccination may have serious side effects, to quarantine sick people who are contagious, and to prohibit us from consuming certain drugs and foods. Public safety and national security concerns can force travelers to undergo body searches at airports. While these examples of bodily invasions may not rise to the same level as requiring a pregnancy to continue no matter what the health or emotional costs to the woman, they do indicate that there are legitimate societal interests that may override our right to bodily autonomy.
The privacy argument—that we are entitled to live our lives without unnecessary government interference into our private lives—runs up against the realities of the modern world where there is less and less privacy. As the world gets more crowded, more connected, and more complex, personal privacy is becoming increasingly elusive, and the public is becoming inured to it. We no longer have expectations of privacy for conversations on the Internet. Cameras to deter crime photograph us as we walk down the street in major cities. The public increasingly supports government regulation of private behavior that harms others. Recently, municipalities have been passing ordinances prohibiting smoking in public places because they believe that secondhand smoke harms passersby. The AIDS epidemic has led to government efforts to discourage or prohibit certain sexual private behavior, notably gay sex in bathhouses, which might result in disease transmission. In these contexts personal reproductive decisions that have public consequences may not seem worthy of privacy protection.
Neither is the public persuaded that the pro-choice arguments we have been making answer the basic moral question of how one can support reproductive choice when one believes that bad choices are being made or that having the choice in itself leads to bad results. It is generally agreed that it is an essential part of being human, and is therefore morally good, that individuals have the choice and the ability to make personal decisions, rightly or wrongly, about how they will lead their lives. The public therefore generally supports individuals having the most liberty and freedom possible to determine the course of their lives. But abortion is seen by many as a choice not worthy of human dignity and freedom because it results in the unnecessary death of an unborn child. In this view abortion could be eliminated if women would only make the unselfish decision to have the baby and either rear it themselves or give it up for adoption. How can one support abortion's being legal if you think it facilitates women making seriously bad or immoral choices?
Traditional pro-choice arguments have not provided much guidance either when individuals confront the difficult questions that new reproductive technologies present. Reproductive science has developed to the point where genetic engineering and even human cloning are possible.
These technologies not only will enable parents to guard against their children's inheriting certain genetic diseases, but also may in the future allow parents to select certain genetic qualities that they want in a child. Cloning will permit a child to be conceived by replicating the genes of one person, rather than by mixing the genes of a mother and father.
New technologies are enabling the human race to assert dominion over its evolutionary future. The technologies will allow us to choose the genetic makeup of our progeny. This in my view is so dangerous that I cannot reconcile it with the absolute right to reproductive choice. These new technologies present difficult moral questions, whether or not one wishes to use the technologies oneself. Their advent makes it clear that reproduction is a matter for all of society to be concerned about. Personal decisions about reproduction do have public consequences.
The lack of relevance of traditional pro-choice arguments to these issues says to me that the world has changed and pro-choice arguments haven't. We have less privacy in the beginning of the twenty-first century than we did when we began advocating for legal abortion in the 1960s. New technologies are presenting new choices and new dangers that we have not addressed. These new technologies make the role of men in reproduction even more uncertain if women can reproduce on their own. The danger that new reproductive technologies may facilitate bad choices has become a more acute moral question.
Traditional pro-choice arguments do not provide as much guidance as the public needs and deserves. I submit that traditional pro-life arguments don't either. Traditional pro-life arguments do not distinguish between various life forms or between egg and sperm combined in a petri dish or in a fallopian tube. Respecting life, however defined, does not provide a basis for analyzing whether genetic engineering is a good thing or whether human cloning should be permitted. A more sophisticated analysis of these issues is needed from both the pro-choice and pro-life camps.

The Unchanging Nature of Public Opinion on Abortion

In one sense the pro-choice movement is a victim of its own success. It scored an enormous victory in 1973 when the U.S. Supreme Court in Roe v. Wade declared state criminal abortion laws unconstitutional. The political fights that were left—defending Roe, fighting the appointment of judges who would overturn it, and fending off state restrictions on abortion access—though clearly vital, appeared less compelling, and as a result over the years there was decreasing passion in the pro-choice movement, especially among young people. As of 2003 those younger than age forty-five have never lived as adults when abortion was illegal, and thus do not know firsthand the danger of abortion being illegal. These young people benefited from the reproductive health services, including abortion, that Planned Parenthood and others provided so competently. Young people don't appreciate the consequences of Roe v. Wade being overturned and abortion's being made criminal again. As Katha Pollit of the Nation said, the pro-choice movement concentrated on the larger political battles and the provision of needed services and "we've let the grassroots education and activism slide." As a result, many young people not only support increased restrictions on abortion access but even favor abortion's being totally illegal.
Compounding this apathy and ambivalence, few abortion supporters talk about abortion positively. Many supporters of choice carefully distinguish between being pro-choice and pro-abortion. Many say, "I would never have an abortion, but it should be legal." President Bill Clinton, when he talked about abortion, said it should be "safe, legal, and rare." If something is good, why should it be rare?
The result is that while public opinion has been relatively static on abortion for the last thirty years, some polls show that the support for the pro-choice position has recently been weakening. Support for a fully pro-choice position (abortion should always be legal)—as for the fully pro-life position (abortion should never be legal)—was never that strong to begin with. Approximately 20–25 percent of the American people support each position, with the remaining half of the American people having a mixed position. These figures have remained remarkably constant over the past quarter century.
Two years after the 1973 Supreme Court decision in Roe v. Wade, the Gallup Poll first asked the American people for their opinion of the legality of abortion. The Gallup Poll of April 1975 reported that 21 percent of the American people said that abortion should be legal under all circumstances, 54 percent said that it should be legal only under certain circumstances, and 22 percent said that it should be illegal in all circumstances. In a poll taken in May 2002, a quarter of a century later, Gallup reported "very similar" results: 25 percent said abortion should be legal under all circumstances, 51 percent under certain circumstances, and 22 percent illegal in all circumstances. The slight differences in the results fell within the margin of error for the polls.
In the twenty-five years between these two polls there has been an acrimonious national debate—political, legal, religious, moral, medical, and sociological—over abortion. And national opinion, at least as recorded in the Gallup polls, hasn't changed significantly. However, and more ominously, other polls have shown a declining support for abortion rights in recent years.
In a nationwide poll done in November 2002 Zogby International reported that 22 percent of those surveyed said they supported abortion always being permitted, while 25 percent said it should never be permitted. These results are similar to, and within the margin of error of, the Gallup polls. But the Zogby poll went further and asked if the respondents were currently more or less in favor of abortion than they were a decade ago. Twenty-two percent of respondents said they were less in favor, while only 11 percent said they were more in favor. Younger people tended to be more opposed to abortion than those in the baby boom generation. One-third of people ages eighteen to twenty-nine said that abortion should never be legal, while only 23 percent aged thirty to sixty-four said this, and 20 percent over age sixty-five. This bodes ill for the future of reproductive freedom.
On the twenty-fifth anniversary of the Roe decision in January 1998, the New York Times conducted a poll jointly with CBS News and reported, similar to Gallup, that the American public was "irreconcilably riven" over abortion and that "despite a quarter-century of lobbying, debating and protesting by the camps that call themselves 'pro-choice' and 'pro-life', that schism has remained virtually unaltered."
On some issues surrounding abortion, public opinion seems impervious to change. I was once on a call-in television talk show where I debated parental consent laws with two supporters of these laws. Before the show the audience in the studio and those at home calling in and sending in e-mails registered their views on the issue. They were 75 percent in favor of parental consent laws and 25 percent opposed (about the same as the national polls). After over an hour of vigorous debate where I, at least, thought I was extremely persuasive, the producers took another poll of the audience in the studio and at home. The result was identical—75 percent in favor of parental consent laws and 25 percent opposed. I hadn't changed a single mind. Maybe those watching were not persuadable, but I also had not yet developed the arguments in this book.
Not only, according to the 1998 Times/CBS poll, was the American public as a whole split on the abortion issue, but so were individual Americans. A majority supported the Roe decision and believed that abortion should be legal and a matter for a woman and her doctor to decide. Half of all Americans simultaneously believed that abortion was "the same as murdering a child," yet often "the best course in a bad situation." While saying that abortion was not the government's business, most Americans in the poll supported government restrictions on abortion access, including waiting periods, restrictions on funding, and a ban on certain abortion procedures. And while saying that the abortion decision was the woman's to make, an overwhelming majority disapproved of abortion after the first trimester, and increasing majorities opposed allowing abortion for economic reasons, or because the woman would not marry the father, or because having a child would interrupt a young woman's education. On the other hand, there was strong support for abortion being legal when the woman "had been raped, her health was endangered or there was a strong chance of a defect in the baby."
Many of us in the pro-choice movement summarized this state of affairs by saying that the average American supported abortion rights for "rape, incest, and me." About the only things that were clear from the polling were, first, that any polling results on abortion should be read skeptically; second, that polls fail to capture the realities of women's reproductive lives; and, third, that the American people appeared to hold totally contradictory ideas about abortion simultaneously. They approved of choice but not of abortion. They approved of women making the decision but not the decisions that were made. They did not want the government involved but approved of the steps that government did take to reduce abortions.
Reporter Carey Goldberg called the gradations in support or opposition to abortion, which varied by the particular circumstances, a "hierarchy of sin." Peter Steinfels, a Times religion reporter, said that the poll results reflected America's "bad conscience about abortion" and a "considerable moral confusion."

The Moral Confusion and Political Weakness of the Pro-Choice Movement

In 1995 Naomi Wolf wrote an article for the New Republic arguing that the pro-choice movement was weakening because it had failed to address this moral confusion. The piece, entitled "Our Bodies, Our Souls," accused the pro-choice movement of relinquishing "the moral frame around abortion" and of ceding "the language of right and wrong to abortion foes." Wolf asserted that the abandonment of an ethical core had caused the pro-choice movement to lose political ground: "By refusing to look at abortion within a moral framework, we lose the millions of Americans who want to support abortion as a legal right but still need to condemn it as a moral iniquity." For Wolf, abortion was a "necessary evil" and a "sin."
Her prescription was:
to contextualize the fight to defend abortion rights within a moral framework that admits that the death of the fetus is a real death; that there are degrees of culpability, judgment and responsibility involved in the decision to abort a pregnancy; that the best understanding of feminism involves holding women as well as men to the responsibilities that are inseparable from their rights; and that we need to be strong enough to acknowledge that this country's high rate of abortion—which ends more than a quarter of all pregnancies–can only be rightly understood as what Dr. Henry Foster was brave enough to call it: "a failure."
Putting aside the fact that Wolf ignored that there are traditions of theological support for birth control and abortion in virtually all the world's religions, she hit a nerve when she called abortion evil, a sin, and a failure. She should be credited with trying to frame the issue in a new way in order to advance it. However, I could not agree with either her diagnosis or her cure. I could not admit that I had worked to advance "evil" and "sin." I had always felt that my colleagues at Planned Parenthood and I worked within a moral and religious framework. We believed that there were responsibilities that went with the exercise of reproductive rights. But Wolf's diagnosis that we were losing political ground because we did not have an ethical core had to be addressed.
Because of the less-than-overwhelming public support for unfettered reproductive choice, the pro-choice movement has been losing ground in the political arena. Ever since the Roe decision a steady stream of federal and state legislation has been enacted designed to overturn Roe's result. Legislation has restricted access to abortion services by denying Medicaid reimbursement for abortion, prohibiting abortions from being performed in public hospitals, requiring minors to notify or get the consent of a parent before an abortion, criminalizing certain abortion procedures, and requiring a husband's consent before his wife may have an abortion.
The pace of legislating appears to be accelerating. In the years between 1996 and 2001, Planned Parenthood reported that 264 pieces of anti-choice legislation had been enacted by state legislatures around the country. By July 2003 NARAL Pro-Choice America reported that the number had risen to 335. I used to think that this was a result of pro-life forces being better organized politically than pro-choice forces are. This may be true, but there is a lot more to the pro-choice political problem than our relative inability to get our supporters to the polls to vote our way. Our problem, I believe, is with our approach to the issue of choice.

Why We Need to Fight a New Battle for Choice

The impetus for this book grew out of a very simple but heretical question. How many more pieces of anti-choice legislation will it take to get the pro-choice movement to rethink its approach to the issue?
The pro-choice movement isn't making major headway with the American public. We are losing ground politically. Roe hangs by a thread. A change of one or two members of the Supreme Court could lead to its overturn.
This state of affairs is not what we in the pro-choice movement want.
I believe that to win the judicial battles and political battles we first must win the battle for the hearts and minds of the American people. We have failed because we have not fought this battle with ideas and language that the American people would understand and agree with. If the American people have moral confusion about abortion, then the fault lies with we who argue on behalf of reproductive rights. We haven't presented abortion within a framework or a system of ideas that is coherent and makes moral sense.
It has been said that no social change is permanent unless it survives two generations. We have been through a generation since Roe. We don't want America's negative opinion of abortion, which seems to have solidified since Roe, to last another generation and become permanent. We don't want abortion allowed grudgingly and only for the


On Sale
Jul 6, 2005
Page Count
352 pages

Alexander Sanger

About the Author

Alexander Sanger, the grandson of Margaret Sanger, served as the President of Planned Parenthood of New York City and its international arm, The Margaret Sanger Center International from 1991-2000. He is currently a Goodwill Ambassador for the United National Population Fund and Chair of the International Planned Parenthood Council. He lives in Manhattan with his wife and three children.

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