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Book Review
Abortion in the USA and the UK
Colin Francome
ISBN: 0-7546301-5-3 2004 180 pages Ashgate Publishing, Aldershot, UK
Heather James
School of Nursing and Midwifery, Flinders University, Adelaide, SA
Professor Colin Francome is a Reader in Medical Sociology and Director of Medical Research, the Health Research Centre of Middlesex University, UK. He is 'well known for his book Abortion Freedom and as the main author of Caesarean Birth in Britain'. He has extensively researched aspects of abortion in the UK: in particular the attitudes of the general population and medical practitioners towards the acceptability and availability of abortion services for women in the UK.
Chapter One is an introduction that provides a historical perspective from the mid to late 1800s to 2002, on the evolution of opposing positions on women's right to abortion. In particular, he examines various eras' attitudes towards reproduction and population control especially from the view of class. For example, at one point it was assumed that the poorer nations and the poor were to blame for their own circumstances and it was up to them to control their fertility. Francome also explains the position of the various political and religious groups. For example conservatives were more likely to be anti-abortion and socialist groups were more likely to be pro-choice, and this trend is still applicable in the USA, UK and Australia.
Francome identifies the 'straw men' used in the anti-abortionist discourse: such as the claim that the risk of breast cancer doubles after one abortion and increases even further with each subsequent abortion. He refutes this, but unfortunately does not provide a source of evidence. Pro-choice groups are not above using similar 'scare tactics', particularly when claiming the high numbers of maternal deaths from illegal abortions. These numbers are very difficult to substantiate and must be viewed as, at best, educated guesses.
Chapters Two and Three examine the experiences of abortion in the USA and UK respectively since its legalisation or decriminalisation. These experiences cover religious, social, political and legal issues. In both chapters Francome identifies the social structures that have either supported or restricted abortion. My main criticism of these chapters is that the numerous relevant statistics would have been much easier to read and comprehend if they had been presented in table form rather than in text. Francome compares the USA with the UK, arguing that in the former, abortions are provided in stand alone clinics, making them more visible than the UK where this service is provided in hospitals. He also examines medical abortions (as distinct from surgical abortions); regional differences in abortion rates; international comparisons (noting that the USA rate is marginally lower than that of Australia); cost and travel for abortion; declines in the abortion rate; the effect of legal abortion on crime; and particularly, the violent attacks on abortion clinics.
The author discusses events in the UK from the perspective of the abortion providers; the profiles of the women who have abortions; the particular experiences of abortion in each country in the UK; the guidelines produced by the Royal College of Obstetricians and Gynaecologists; and the debate over women's right to choose.
Chapters Four and Five explain events leading to legal abortion in the two countries and demonstrate their entirely different pathways. These chapters discuss events in the UK such as concerns for women's health; the opinion of the population on sexuality since World War Two; the strength of pressure groups; the composition of the House of Commons and its influence; and the tactics used by the various pressure groups and parliamentary action. In Chapter Five Francome contrasts the events in the USA with those of the UK, especially with regard to the greater strength of the women's movement in the USA; the influence of the American Constitution; and the attitudes of the medical profession.
Chapters Six and Seven examine the politics of abortion in the USA and the UK. In Chapter Six Francome identifies and explains the politics of the various pro and anti abortion groups in the USA; the kind of political action taken; and the Supreme Court decision on the legalisation of abortion and the issues it did not address. Chapter Seven looks at anti-abortion groups in the UK; pro-choice organisations; strategies used to try to restrict abortions; a reduction in the gestational age when abortions may be performed; women's views on the law; the differences in the law in Northern Ireland; and what activists believe should be the law in the UK.
Chapters Eight and Nine describe the situation in each country when abortions were illegal from the eighteenth century, social issues such as class stratification, attitudes towards women, men and sexuality. Abortion was legal in the UK until quickening. Ironically, it was made illegal in the early 1800s because it was thought to be dangerous for women. After that, women who were found guilty of procuring an illegal abortion could be deported to Australia. Women continued to obtain abortions illegally despite the penalties if they were discovered. The main thrust of Chapter Nine examines the introduction of contraception, and how the arguments used to prevent the use of contraception in the early and mid 1900s parallel the same arguments used today against abortion. There was much debate about the use of contraception to prevent the need for abortion and the spurious argument still continues that if women used contraception they would not need abortions.
Chapter Ten examines the future of abortion legislation in the USA and the UK. The author posits a potential backlash in the USA, particularly with the conservative government currently in power, and suggests that the Roe vs Wade decision may be overturned. This would mean that women would have to travel farther (however he does not say where) for abortions, but history has shown this is not a deterrent.
Francome is obviously alarmed by the current political regime in the USA and its attitude toward abortion. He warns about the possible restrictions of the current laws in the USA which allow most women ready access to abortions. If these laws are repealed, he warns that women, particularly poor women, will be severely disadvantaged. He presents a strong case, both historically and socially, that when abortions are illegal, women who have the need will continue to procure them, often placing themselves in jeopardy. This occurs regardless of the anti-abortionists' strategies to make abortion illegal and stigmatised. Francome makes a case for the laws to become more liberal in the UK and suggests a political strategy to enable change.
Francome takes the Pro-choice stance that abortions 'will not be legislated out of existence' and that women need to be given 'the freedom to choose and to provide the education that enables them to make informed decisions' (p.170).
There is much in this book that is relevant and applicable to the Australian experience, and it offers a good record of historical, socio-political and legal aspects of this most contentious and vexed element of women's reproductive health from a global perspective.
There are however, some criticisms that can be made of this text. Of particular note are the many typographical errors which are a distraction. It would also be helpful to have a glossary of acronyms of the various organisations named throughout the book.
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