The right to have or not have children; the right to have both children and a selfhood not dependent on them; these are still being fought for, and this fight threatens every part of the patriarchal system. We cannot afford to settle for individual solutions. The myth that motherhood is "private and personal" is the deadliest myth we have to destroy, and we have to begin by destroying it in ourselves.
adrienne rich, On Lies, Secrets, and Silence
Xhere are no individual solutions to the dilemmas posed by reproductive politics because "choices" are not merely the product of self-motivated desires but depend on conditions existing in the society. The ultimate dilemma for those who seek to enhance reproductive and sexual freedom is how to create a sense of collective purpose—of feminist and social solutions—concerning matters that seem so intrinsically personal and private. Since 1970, feminist activism and the right-wing reaction against it have succeeded in deprivatizing the abortion issue and have brought it squarely within the arena of political discourse. Moreover, the practical content of feminist abortion politics has implied social solutions. To demand that the state provide uniform, funded, and high-quality abortion services to all women has been to acknowledge that abortion should be a matter of public responsibility and not of "private choice" alone.
Yet feminist thinking about abortion continues to reflect two assumptions that obscure the ways in which abortion is a basic need of
women, which is different from either a "necessity" (unchosen) or a "choice" (unnecessary). These dubious assumptions are, first, that abortion is a "necessary evil" that, with changing conditions, will disappear; and second, that the only available framework for grounding abortion as a right is that of "privacy," or "individual liberty." In what follows, I offer a critical view of both assumptions. 1 then consider areas of future practice for feminists concerned with translating reproductive "choices" into social and cultural realities.
1. The need for abortion will not disappear. In writing a book about abortion, it was not my intention to inflate its significance. Abortion in itself does not create reproductive freedom. It only makes the burdensome and fatalistic aspects of women’s responsibility for pregnancy less total. It does not socialize that responsibility, empower a woman in her relations with men or society, or assure her of a liberated sexuality. It only allows her the space to move from one point in her life to the next, if she is a heterosexual woman; to navigate some of the more oppressive patriarchal and institutional forces that are beyond her control. Abortion is but one of many social conditions that encompass women’s education, employment, health, reproductive choice, and economic and sexual self-determination. As such, it is both minimal and indispensable.
Yet, since the late 1970s, a negative view of abortion seems to have penetrated feminist thinking as well as the dominant culture. Typically, it takes this form: "Of course, nobody likes abortion; we just think there should be a choice." Sometimes this defensiveness grows out of a pragmatic concern to win a broad base of support. Even committed feminists in the movement for reproductive rights lament that abortion is "a hard issue to organize people about," one that fails to uplift people’s spirits or generate joyful, proud symbols (the coathanger is seen as a "last resort"). Sometimes feminist ideas themselves absorb and reflect cultural forces that project abortion as a "necessary evil." Thus Adrienne Rich wrote in the mid-1970s: "No free woman, with 100 percent effective, nonharmful birth control readily available, would ‘choose’ abortion"; and "abortion is violence: a deep, desperate violence inflicted by a woman upon, first of all, herself."1
The basis of this victimizing, victim-blaming position is a perspective that reduces women’s condition universally to "male violence." It is also a strain of feminist tradition that idealizes motherhood, implying that the termination of every unwanted pregnancy is somehow a tragedy. Whatever its intention, this view does not accord with the facts. Many, perhaps most, abortions performed today (and, as far as we can tell, through much of history) are not the product of "grim, driven desperation," as Rich calls it, but of women’s sober determination to take hold of their lives and, sometimes, of a sense of enlarged power for being able to do so. That abortion may be painful or unpleasant does not make it "violence against oneself" any more than a painful divorce or a mastectomy is "violence against oneself." My point is not to deny that abortion often involves pain in the experience of individual women, but to understand that experience in social terms.
Nor can we expect that "in a society where women entered sexual intercourse willingly, where adequate contraception was a genuine social priority, there would be no ‘abortion issue/"2 This echoes the view of nineteenth-century feminists that abortion will be "unnecessary in a future world of egalitarian respect and sexual discretion."3 For the reasons discussed in Chapter 5, we cannot assume that there will ever be a "100 percent effective, nonharmful" contraceptive in a human (not merely a technical) sense. While the terms of the need for abortion will change as technology and social conditions change, the "abortion issue" will not go away.
The view of abortion as a necessary evil bom out of desperate circumstances is a liberal accommodation to recent waves of antiabortion (and antifeminist) ideology. It is a clearly mistaken view, since the conditions underlying rising abortion rates in the 1970s and 1980s have on the whole involved a greater expansion of women’s relative power in American society than at any other time. Indeed, the historical material presented in this book seems to suggest a rough hypothesis: The easing of women’s access to birth control and abortion (which are positively related) coincides with periods of their increased social power and status; while restrictions on that access usually indicate a broad-scale attack on women’s sexual and social autonomy and on feminist movements. Our unnecessarily high rate of abortions in the U. S. relative to other so-called developed countries results not from feminism but from residual conservative influences in the society—influences that inhibit the institutionalization and cultural and moral acceptance of young women as birth control users, and, thus, sexual actors.4
The "necessary evil" concept oddly forgets the spirit of buoyancy infusing not only feminists but masses of women after Roe v. Wade. Suddenly the years of terror, of silently fearing pregnancy, of sneaking off to possible sterility or death, and of sex ridden with shame were with a few judicial words going to end. It was a naive faith, for the last several years have shown that deep-rooted ideology and noncompliant administrative and clinical practices were too powerful for a Supreme Court ruling to reverse. The buoyancy was there nonetheless because abortion—easily available, cheap, administered under safe, hygienic conditions early in a pregnancy and in an ambience free of stigma and guilt—is a component (not just a condition) of women’s liberation. What makes abortion "awful" is the shame and guilt caused by two heavily ideological notions that all women in the society still learn to some degree: (1) the association of fetus with "baby" and the aborting woman with "bad mother," and (2) the assumption that sex for pleasure is "wrong" (for women) and that women who indulge in it have to pay a price. Leaving aside these timeworn misogynist ideas, the circumstances in which abortion occasions misery and suffering are (1) when it is delayed or illegal and results in serious medical complications; or (2) when a pregnancy and child are desired, but social or economic conditions weigh against it. Under the second set of circumstances and most of the first, the surrounding conditions—those that prevent people from having wished-for children securely or from having abortions safely—are tragic and impede freedom, not the abortion itself. Along with a heterosexist culture in which a woman feels she must "prove her adequacy as a woman by getting pregnant" or "look for economic security to a man, getting pregnant as a by-product,"5 these are the conditions that a movement for reproductive freedom must seek to transform.
Rather than apologize for abortion, feminists must proclaim loudly— as they did in the late 1960s and early 1970s—that access to safe, funded abortion is a positive social need for all women of childbearing age. Abortion is a necessary, though far from sufficient, condition of women’s essential right and need, not only for bodily health and self-determination, but also for control over their work, their sexuality, and their relations with others— including existing children. From this perspective, abortion conducted under safe, affordable, and stigma-free conditions is neither a necessary evil nor a matter of private choice. Rather, it is a positive benefit that society has an obligation to provide to all who seek it, just as it provides education and health benefits. Put another way, abortion is not simply an "individual right" (civil liberty) or even a "welfare right" (for those "in need") but a "social right."
What does it mean to talk about abortion as a social right or, more accurately, a social need? First, it means that access to abortion (as distinct from the actual experience) is necessary to women’s well-being and self- determination; therefore, it is closer to a "necessary good" than a "necessary evil," whatever discomfort it may entail. The farther a society moves toward transforming the oppressive socioeconomic and cultural conditions that encumber the meaning/experience of abortion, the more will abortion become a genuine tool of freedom rather than an occasion of misery. In this regard, it is similar to work or divorce. Second, it means that the need for abortion is universal in the sense that its availability is essential to all women, for it defines the terms and conditions of "womanhood" in the society; and it is specific in the sense that the need grows out of a particular set of problems. Access to safe, legal abortion is a very different kind of need depending on whether a woman is a fifteen-year-old high school student, a single working woman trying to raise one or two children already, a black woman suffering from hypertension or diabetes, or a recent immigrant trying to get an economic foothold in the U. S. Finally, it means embedding the right to abortion in a much broader array of health, social welfare, and sexual needs.
2. The right to abortion rests not only on "privacy" but on solidarity; it is social and individual at the same time. An expansive view of the conditions of reproductive choice typified the feminist movement for reproductive rights that emerged in the 1970s. Many feminists understood reproductive freedom as involving much more than access to safe, legal abortion. The Committee for Abortion Rights and Against Sterilization Abuse (CAR – ASA), for example, was formed in 1977 in New York with the idea that the "right to have children," as well as the right to avoid pregnancy, was essential to women’s control over reproduction. It recognized that access to abortion services was the chief problem for some women, but for others, particularly for women of color or disabled women, state policies to restrict their childbearing could be more pressing. Thus CARASA’s organizational principles spelled out the conditions of reproductive freedom in the broadest terms: "No category of women—poor, young, disabled—should be excluded from reproductive freedom. To really have that freedom, we require: abortion services for all women, regardless of income; safe, well designed birth control; sex education in the schools; good and accessible pre – and post-natal and maternal health care; and the right to conduct our sex lives as we wish and with dignity." CARAS A also called for basic economic and social changes: equal wages for women, decent housing, adequate welfare benefits, reliable child care and good schools, an end to toxic environments that threaten fertility, and an end to government – sponsored sterilization abuse.6
This perspective usefully shifted the focus of abortion debate from individual (moral) choice to social need. In the twelve years between the Hyde Amendment and the Webster decision, however, progress toward a socially oriented feminist politics of reproductive rights has been deflected by three developments: the increasing deployment of technologies for monitoring pregnancy; the AIDS and drug epidemics; and the challenge, from both right and left, to the integrity of "rights" discourse of any sort.
As mentioned earlier, both medical techniques and criminal procedures have been used with growing frequency in the late 1980s to monitor women’s (chosen) pregnancies. Elsewhere I have written about ultrasound imaging and other techniques for monitoring fetal development in utero as creating a kind of self-fulfilling prophecy, in which both "fetal person- hood" and "fetal distress" are the artifacts of the machines designed to measure them.7 In addition, the technologies reinforce a sense on the part of middle-class pregnant women (those with access to high-tech obstetrical services in private hospitals) that a failure to submit to thorough medical surveillance will indeed leave them personally to blame should anything go wrong with the pregnancy. This punitive attitude is strongly verified in the law, in ways that affect poor women most directly. Fetal rights advocates in numerous states and localities have succeeded in getting social welfare, probation, and hospital officials to adopt policies defining "child abuse" in such a way that pregnant women become "legally accountable for the health and safety of the fetuses they carry." These "fetal protection" policies, aimed coercively at the pregnant woman, have taken the form of forced cesarean sections, prosecutions for drug or alcohol use, and harassment by state or medical agents for other behavior deemed detrimental to the fetus.8 The AIDS and drug-addiction epidemics, in a dominant culture that heavily stigmatizes people with those conditions, contribute to the climate of blame. This is particularly the case for pregnant women who are drug-addicted or HTV-infected or both—who in the United States are overwhelmingly poor women of color. These women and their infants are more likely to be screened and tested than are women who use private hospitals; some of these women are also being subjected to government pressures to undergo sterilization or abortion. As a recent report for the New York City Commission on Human Rights observes, "the compelling state interest in fetal survival seems to evaporate when the mother and/ or fetus have been exposed to HIV."9
With the accumulation of state and medical assaults on the autonomy of pregnant women as reproductive decision makers—especially if those women are poor and nonwhite—the need to assert women’s bodily integrity as a privacy right has seemed more urgent than ever. Yet the inadequacies of this framework become painfully apparent when we consider its relation to the doctrine of individual responsibility of pregnant women for risk or harm to the fetus. This doctrine incorporates in law the ancient patriarchal idea of woman as vessel or carrier of the unborn but additionally imposes on the individual woman criminal responsibility and punishment for her behavior during pregnancy. In other words, fetal rights strategies take the principle of a woman’s individual control over reproduction and invert it with a vengeance: she alone is the agent of the pregnancy’s outcome, she alone is called to account for the fetus’s health and well-being (and her own, although that is of little concern to policy makers). If we go back to the situation of the poor (black, Latina, or white) woman who is addicted to cocaine and pregnant, we begin to see that the liberal individualism underlying both the language of criminal responsibility and the language of "free choice" is inadequate to tell her story. Both languages represent the fiction of her free agency, obscuring a social reality in which no alternative—neither abortion nor childbearing, nor certainly jail—is a free one, much less a means toward health.
Does this mean that liberal rights are bankrupt, that it makes no sense any more to talk about "reproductive rights"? The 1980s found the very concept of rights embattled from all sides. As the Supreme Court made clear in Webster as well as in the affirmative action decisions of 1989, neoconservatism in the law is committed to undoing constitutionally grounded claims to fundamental rights for women and people of color in the areas of reproduction, sexuality, and employment. Such rights—achieved through political struggles of the radical movements of the 1960s and 1970s—foundered against the interventionist prerogatives of the neoconservative state under Reagan and Bush. But "rights" as such also came under attack during this period from left-wing and feminist quarters. According to Foucauldian and postmodernist critics, the notion of a "right" is based on a fiction, since it assumes a coherent, rational, and essentially ahistorical "self" or "person" who is its subject. Subjectivity, or "person- hood," is in this view always historically contingent, always the result of discrete power relations, and thus never a reliable foundation for uni- versalistic claims.10 Similarly, advocates of critical legal studies have pilloried rights as both incoherent and "indeterminate," since rights discourse (a) can never resolve the tension between pockets of "freedom" for individuals and the need for government restraints to protect those freedoms; and (b) provides no "objective, apolitical basis" for resolving conflicts between different rights claims (for example, between "women’s rights" and "fetal rights").11
Finally, some feminist scholars in the 1980s also challenged liberal concepts of privacy and individual rights, including the notion of a "woman’s right to choose" (abortion) and reproductive rights. Echoing feminist advocates of protective legislation in the early twentieth century, writers such as Catherine MacKinnon and Mary Ann Glendon have argued that liberal privacy is a doctrine that leaves women vulnerable to sexual exploitation in a still male-dominated society; that privacy is a "male ideology" and Roe v. Wade a "masculine decision," inasmuch as it emphasizes "the separateness, the rights, and the self-determination of individual women" rather than addressing the roots of male (sexual) dominance as such.12 Eschewing rights altogether (like the white male advocates of critical legal studies), these legal writers picture women as unmitigated victims who can be saved from male sexual exploitation only through state – sponsored protections. Indeed, they invoke Rich’s view of abortion as an expression of male domination and "violence against women" rather than of women’s efforts to achieve control over their own sexuality and fertility.13
From the outset, a major purpose of this book has been to push beyond the boundaries of "a woman’s right to choose"—which means a critical feminist rethinking of the limits of privacy and choice as a framework for reproductive rights theory. Clearly, "liberty" poses serious problems as a basis for such a theory insofar as it pits one abstract rights-bearer against another, without reference to social conditions or context. Its exclusionary, adversarial connotations cannot account for the poor, addicted, or HIV – infected woman for whom pregnancy (at a 50 percent chance the baby may not be infected) offers her best hope in life. Nor, as I have argued repeatedly, do the concepts of "privacy" and "personal choice" include any ground for making positive, affirmative claims on state services. Can we nonetheless retrieve a theory of reproductive rights, or women’s rights to bodily integrity, from the heavy baggage of liberal individualism and exclusivity with which it has been encumbered? Can we develop a socially relevant definition of rights that maintains some notion of women’s moral and political agency, both as individuals and as members of collectivities?
The critics of rights, I would argue, commit the fallacy of taking "rights analysis" on its own most liberal terms, as descriptions of competing interests belonging to abstract individuals. They then blame rights for failing to encompass a transcendent, objective set of norms above the historical conditions and political claims of real actors. Rights, however, are no more or less than a discursive strategy; they are, in Frances Olsen’s words, "hortatory" rather than either "descriptive" or "analytic" and cannot substitute for the vision of a just and democratic community that we need in order to evaluate particular claims. Moreover, the view of women as passive victims of male dominance ignores two hundred years of women’s conscious activity (documented in this book and elsewhere) on behalf of what they have perceived to be their "right to control their bodies." The urge to create a rhetoric that universalizes women’s claims and connects them to some larger source of validation (human rights, the rights of person – hood) is on some level indispensable for any disenfranchised or marginalized group seeking recognition as more than just a "competing interest." We have to distinguish the abstract individualism that rhetoric has generated in western liberal, legal, and feminist traditions from the collective, communitarian dimension of rights claims in diverse contexts of political action. In such contexts, rights become one critical discourse through which collective identities are defined, publicly announced, and tentatively achieved in particular historical moments. They are thus part of the narrative through which collectivities (women, blacks, gays and lesbians) become constituted as public selves and are empowered to engage in political action. In short, we could not abolish "rights talk" without abolishing politics altogether.14
Rather than accepting the dichotomy established by classical liberalism between individual autonomy and social interdependence—including state, or public, intervention—we need to apply the concept of social or communal rights to the areas of reproduction and sexuality. As Jennifer Nedelsky has written, "a tradition which has conceived of the relationship between the individual and the collective primarily in terms of the threat of the latter does not provide an adequate basis for defining individual rights in the context of affirmative responsibilities of the state."15 A social rights perspective would emphasize, rather, the "interactive and communicative component" of this relationship,16 thereby redefining what we mean by the "right to privacy" or the "right to choose." Applying a state constitutional provision guaranteeing the "right to be let alone and free from governmental intrusion into [their] private life" to minors seeking abortion is surely a "redefinition of privacy." For it not only transcends the Supreme Court’s deference to patriarchal family values but helps to constitute young women as sexual-political subjects, in a social climate that overwhelmingly rejects that subjectivity.17 But in order for the "right to control our bodies" or the "right to choose" to become truly "a collective assertion of right in the demand for a new ordering of social possibility/’18 it must address itself to the needs of all women. The social conditions of bodily integrity have to become universally available, and that set of transformed conditions has to become inherent in how we define reproductive (or any) rights.
Creating equality of conditions for reproductive choice means, first, a wide range of social supports that will make having and raising children, or not doing so, a real alternative for all people: high-quality, publicly funded health, maternal, and child care; the elimination of reproductively hazardous environments; and the provision of adequate jobs, incomes, housing, and education. Above all, changes in the social arrangements of child care and reproductive decision making will have to be accompanied by basic changes in the sexual division of labor in the economy and the state. As long as women work in segregated jobs, for low pay and with subordinate status, and must bear primary responsibility for children, there can be no "equality" in reproduction. Finally, the meaning of "reproductive rights" must include the full range of treatment services for women with HIV and women on drugs and respect for their reproductive choices. As CARASA insisted in the 1970s, women must be free to have children as well as not to have them, and the conditions of racism in the society that prevent this must be confronted in any political agenda for reproductive rights.
Second, the conditions of reproductive freedom will have to include cultural as well as socioeconomic changes, specifically changes in the social and sexual relations of reproduction. "Maternal practices" will have to become contributions that men as well as women not only value but achieve. Such changes go way beyond legal reforms such as parental leave benefits, flex-time, child-care centers staffed by men and women, and the like. They require a revolutionary commitment to a cultural revolution that will take hold of families, schools, the media, and ordinary ways of life, even among those in power. The meanings of sex as well as gender will be called into play in such a revolution. Not only the standards of nur- turance and who shall provide it are at stake but the socially sanctioned expressions of desire. In particular, we shall need to develop a set of standards and practices for a revolutionary "sex education." What should be its goals? What new kinds of knowledge, social more than technical, should it generate? How is the sexuality of teenagers to be allowed space while its specific needs are respected? These questions, which are distinct from questions about gender equality, have barely begun to be asked from a feminist perspective. Nor does the introduction of social reforms (including child care, birth control, and abortion services) guarantee that they will be.
Even during the most liberal years of teenage access to abortion and contraception, the potentially liberating impact of that access was muffled by the persistence of a male-dominant culture and social relations of sex. The openness and legitimacy of nonmarital heterosexual activity continued to be encumbered with traditional risks and pain for young teenage women, inasmuch as they played for different stakes (commitment, love, romance) than males, and often lost. A clear feminist vision, an alternative culture of sexuality embracing passion and play as well as love, has not penetrated the consciousness of younger generations; indeed, for heterosexual women, it has not even been articulated. While a lesbian subculture has flourished, the cultural forms—the stories, plays, songs, novels—feminists have created during the past ten years that might have spoken to younger heterosexual women about a different vision of sex and relations with men have mainly revealed women’s anger over what now exists as "love and romance." Yet, as Alexandra Kollontai understood, a revolution in women’s social place and in the relations of reproduction is impossible without a "new morality" of sex and love.19 I do not know what the content of that morality is, except that it must integrate a broad, ecumenical acceptance of multiple forms of pleasure with the principle of respect for another’s body and well-being (which is not necessarily the same as accommodating any of another’s desires). We have responsibilities to others in sexual relationships, as well as our own desires and needs. We must know much more than this, however, before we can teach a "new morality," a feminist morality, to the young.
Within such a culturally and socially transformed setting, reproductive choices will still occur within institutional frameworks. These institutions— above all, the health-care system—must also undergo sweeping and specific changes before reproductive freedom for all women can exist. Institutionalized reproductive services and their political settings, even at their most expansive, have been monopolized by medical and family planning professionals whose concept of "social need" has often been different from that of feminists or women as reproductive health consumers. To defeat the policies of the New Right simply to reinstall a family planning bureaucracy whose priorities are population control and "medically effective" but hazardous contraceptive techniques would be a small victory for feminists. But to contest the medical and family planning monopoly over reproductive politics is not to deny that reproduction and abortion are health related.
It is appropriate to encompass "abortion rights" within a broad and expansive definition of women’s health for two reasons. First, pregnancy is a health issue for women—sometimes in dramatically life-changing or life-threatening ways. To affirm this is to say that access to decent health care and the conditions of physical well-being for all people is a moral question; health and morality cannot be dichotomized. Second, the fact that the reproductive and fertility control services to which most women have access are at present contained within medical institutions means that it is within those institutions that we must challenge the quality and availability of the services. This means challenging the modes of organization and authority within the institutions—transforming the medical system and its dominant ideologies from within.
Abortion is not analogous to tuberculosis inoculations or indeed mastectomy; it has to do with women’s sexual and moral autonomy as much as their physical integrity. At the same time, the appeal to an "individual rights" (moral) framework, in the context of the capitalist state and a privatized medical market, is as inadequate as the appeal to a narrow concept of "medical necessity" to satisfy women’s reproductive and abortion needs. Even during the halcyon days of legal, funded, and presumably unrestricted abortions, medical control over reproductive health services determined in practice the extent of the "personal choice" of abortion, especially for poor women. Individual rights in American constitutional law, as the Supreme Court insists on reminding us, guarantee only that the state will erect no "obstacles," no roadblocks, in our path—for example, will not arrest us on the way to the doctor’s office or shut down the (free market) abortion clinics. These rights will not assure us of money to pay for abortions or that state hospitals will provide them, or will provide them in a decent and humane setting; or even that private clinics will be protected from vandals, arsonists, and exploitative hucksters. And they will not be applied in the name of sexual (as opposed to "procreative") autonomy, since the state reserves the authority to "protect" young women from the sexual consequences of legal abortion. While arguing for an individual rights position, Willis recognizes its limits when she says:
. . . doctors have always been free to withhold treatment they consider unnecessary or harmful. If there were no abortion laws, doctors and hospitals could still deny women "unnecessary" abortions, or even argue (as many antiabortionists do) that abortion causes guilt and depression and is therefore bad for women’s emotional health.20
The abortion experience of the past hundred years confirms that realizing the right to abortion requires putting an end to privatized, class – divided medicine and socializing medical care. This will mean, first, that health needs become one essential ground for abortion and that medical personnel who fail to provide essential services will be publicly called to account. Second, it will mean that, rather than twist abortion into the restrictive framework of pathology and cure, we will broaden the dominant meanings of "medical" (and consequently standards of reimbursement) to include all aspects of health—preventive, reproductive, and socioeconomic as well as remedial. This expansive approach to a concept of reproductive health will affect public and private financing not only of abortion but of contraception, pregnancy, and prenatal and child care.
The concept of a social approach to reproductive health care requires not only a socialist transformation of the health care system, its standards of care, and its methods of distribution but also a new definition of the meaning of "health," a feminist definition. Returning to the social – contextual concept of Judge Dooling in McRae, we may posit that sexual self-expression is itself a basic human need so allied to a person’s physical and emotional well-being as to constitute an aspect of "health" in the widest sense.21 And, since AIDS, this definition must include safer sex, responsible sex, as part of the meaning of sexual self-expression. Further, the principle of control over one’s body must also be incorporated into an expanded concept of health needs, since if things can be done to my body over which I have no control (e. g., forced pregnancy or involuntary sterilization), this impairs my ability to function as a fully responsible (i. e., healthy) human being.
A feminist and socialist approach to reproductive health will transform not only the ideology and methods of medical care in western capitalist societies but their hierarchical structure as well. If "health needs" include those that will save an individual from death or disease and those that refer to basic well-being, then they are the province not only of professionals but of individual "consumers" and social organizations designed to "enforce more uniform—and more liberalized—standards of practice throughout the country."22 These organizations will become part of a larger movement to democratize political control over social welfare programs. The historical conditions in which women may anticipate sharing reproductive responsibility with men, or with the "community as a whole," must be those in which democratic principles and processes are built into reproductive (and all) decision making. That is, we will need a radical social democracy in which domination by bureaucrats and medical professionals is not allowed to repress those whose lives are immediately affected by decisions. But feminists will need to be organized politically as advocates of women’s needs even in a society whose institutions formally embrace the equality of women.
Given such a context, we can imagine concrete situations in which collectively organized social intervention into reproduction, or even "population" matters in a narrower sense, will be not only legitimate but necessary. Society will have to deal with economic and social questions concerning the allocation of resources to communal child-care facilities, the mobilization of men on a systematic basis into child-care activity, and, most difficult of all, the relationship between the responsibilities of collective organizations and those of parents or other related adults for children. Indeed, unless we adopt a crude anti-Malthusian position that refuses to acknowledge any such thing as population problems, we will have to deal with certain "quantitative" concerns—for example, the ways that the age structure of the population affects its capacity to provide collective childcare and educational resources.23 The view of reproduction and parenting as essentially social relationships implies not only a commitment to the legitimacy of social regulation of those areas of human activity but also a rejection of the idea that there is a "natural right" to procreate indefinitely or to procreate at all. That idea must be distinguished sharply from the idea of a socially determined need (of both men and women) to participate in the care and rearing of children, as a distinct and special part of human existence. The latter is essential to a feminist and socialist vision of the future. The former is a remnant of biological determinist thinking (akin to "mother-right") that should have no place in feminist thought.
Yet, even in a society where the collective responsibility for reproduction and childrearing is taken seriously at all levels of public and interpersonal life, will there not still be aspects of reproductive and sexual relations that remain a "personal affair"? In particular, will women not still retain a preemptive claim to reproductive autonomy, especially around questions of abortion and childbearing, based on the principle of "control over one’s body"? Even in the context of revolutionary social relations of reproduction, it will never be legitimate to compel a person to have sex or to bear a child, to have an abortion or be sterilized, to express or repress sexuality in some prescribed way, or to undergo surgical or chemical or other bodily intervention for reproductive or contraceptive purposes. A sense of being a person, with personal and bodily integrity, will remain essential to the definition of social participation and responsibility, under any historical conditions I can imagine.
To deny that there will always be a residual conflict between this principle—which is the idea of concrete individuality, or subjective reality—and that of a social and socially imposed morality of reproduction seems not only naive but dismissive of an important value. In any society, there will remain a level of individual desire that can never be totally reconciled with social need24 without destroying the individual personalities whose "self-realization" is the ultimate object of social life. Can we imagine such a policy, or a revolution in reproductive technologies, that would not arouse women’s sense of usurpation of a process that belongs to them personally, to their bodies? The provision of adequate, universal child-care services or male sharing in childrearing will eliminate neither the tension between the principles of individual control and collective responsibility over reproduction nor the need to make reproductive choices that are hard. But this very tension may be a source of political vitality for feminism, and for whatever new visions of community the twenty-first century will bring.
 When I was growing up in Tulsa, Oklahoma, the local home for unwed mothers was as shrouded in horror and mystery as an asylum or leper colony. Located outside of town in a field off a rural highway, unmistakably "institutional," it drew my fascination by the lifelessness outside its walls and the miserable types I imagined must dwell within. The windows always seemed closed. There were stories of unknown origin that circulated in our high school about a hatchet-wielding killer named "Sparky," a crazy man who haunted the outskirts of town in search of innocent girls or couples who parked on deserted roads to hack to pieces. Somehow the two symbols of lost innocence and the terrors of sex—Sparky and the "home"—became closely connected in the dark shadows in my mind.